RICE & MICE: Ouch, my bursa!

A bursa is a thin, fluid filled sac that helps cushion and reduce friction in joints between the skin, and tendons or between skin and bone. Usually, a bursa only contains a small amount of fluid, like a zipper sandwich baggie with a tablespoon of olive oil in it. Bursitis is an inflammation of a bursa and commonly occurs in the shoulder, knee, elbow, and hip and sometimes the ankle and foot.

Bursitis may be acute or chronic and may be caused by overuse of a joint or trauma to the joint. Trauma or repeated movements can irritate the bursa and cause it to swell. When the bursa swells it takes up more room and there is less room for the other tissues in the joint to move.

anatomy of olecranon bursitis orthoinfo.aaos.org

The most common type of bursitis that affects the elbow is olecranon bursitis. The olecranon bursa lies between the loose skin and the pointy bone at the back of the elbow. The part of the bone that sticks out at the end of the elbow is called the olecranon. Normally, the olecranon bursa is flat, like the zipper sandwich baggie with the tablespoon of vegetable oil in it.

Bursitis will develop in the elbow, due to trauma, when there is a direct blow to the elbow. The trauma causes the bursa to fill with excess fluid and swell. Sometimes olecranon bursitis is called students’ elbow because constant or prolonged leaning or pressure on the elbow against hard surfaces. This tends to be slow in development. Infections can also cause bursitis and finally, certain medical conditions, such as gout can cause bursitis.

Swelling is a typical "first sign" of bursitis orthoinfo.aaos.org

The main symptom of olecranon bursitis is swelling at the elbow. At first the swelling may not be noticeable, since there is loose skin over that part of the elbow. As the bursa continues to swell, there will also be pain with movement and tenderness to touch. An infected bursa may also be red, warm to the touch and sometime the infected bursa will fill with so much pus that it can burst and drain on its own.

Initial treatment for olecranon bursitis, will usually consist of RICE (rest, ice, compression, elevation). The elbow should be iced 15-20 minutes at a time, several times per day and a compressive wrap should be worn. If an infection is suspected, the bursa may be drained in a medical office so the infection can be treated with proper antibiotics. If there is no infection however, RICE and physical or occupational therapy may be used to speed the recovery time.

Another method to speed healing includes draining the bursa and then injecting a corticosteroidmedication into the bursa. The steroid injection is a strong anti-inflammatory medicine and will usually alleviate the swelling and speed recovery, usually within one week.

Complications of corticosteroid injection can include infection. If the bursitis is severe and does not respond to conservative treatment, surgery may be done to remove the bursa (a bursectomy). In the case of a chronic bursitis, elbow pads should be used to cushion the elbow and activities should be changed or modified to reduce the irritation from direct pressure on the elbow.

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