I had a great delight in shocking people this week with an injury. Being a court sport player, bumps and knocks are part of the contract and after a spectacularly impressive sideways dive (that resulted in not much effect at all) my elbow came into contact with the floor and I instantly knew what was going to happen. Having had this condition before where the olecranon process (bony bit of the elbow) has been hit before, I knew exactly what was going to form on my elbow the next day. Now some of my clients found great delight in this as it meant that I couldn’t utilise my elbow in treatments. However necessity is always the mother of invention and I have been adapting my usual style and employing more of my left arm to still administer treatment. There is always an alternative.
So what is this ugly ‘bump’ and lump on my elbow? It’s rather indiscrete until it is pointed out and then you do notice this rather hideous looking growth on someone’s elbow that looks like a great abnormality. Often called Students Elbow or Popeye Elbow the appearance of the bump is from the inflammation of the olecranon bursa. It can be caused by direct impact such as bumping it, or by continuous pressure on the elbows – as a student would do when the lean on their elbow studying. Oddly it can often be found in tradesman who have to crawl constantly through cramped or small spaces.
Olecranon Bursitis is a result of inflammation of the Olecranon Bursa, a small flat fluid sac that lies between the olecranon process and with any bursae in the body, it is a fluid filled sac that blows up and accumulates more fluid after impact or when two structures may come into contact with each other. In the case of the olecranon bursa, it lies between the proximal (closest to the body) bony end of the ulna and the skin. It allows the bone to move freely underneath the skin. There is a loose flap of skin at the elbow that helps to facilitate movement in flexion/extension and underneath this skin is the olecranon bursa.
When direct impact or constant pressure is applied here, the bursa can be irritated and begins to fill with more synovial fluid. As more fluid accrues in the space, the bulge begins to form and grow. It can come as a slow onset after impact and will swell with the accumulated fluid or can occur over several months of prolonged irritation such as in the case of a tradesperson or student. When the condition occurs out of the blue and with redness and swelling, this may indicate a more sinister cause of internal infection which can sometimes be related to rheumatoid arthritis or gout. Any redness associated with the swelling can often indicate infection, which can be caused from a lesion on an already inflamed bursa. An insect bite or scratch can lead to infection if the skin is broken and the fluid becomes infected, which then leads to the formation of pus inside the sac which is a more serious stage of the condition.
Treating the condition is relatively simple. It’s an inflammatory condition and usually with bursitis the most prevalent thing to do is avoid the irritation. That can mean stopping movement or positions that aggravate the condition. It has been noted that some exercise people are prone to the condition when involved in long holds of the plank position… so you would automatically try to avoid this position to avoid aggravating the bursa. In this case it is very similar to a knee bursa which has a similar formation either above or just below the patella. So not ‘moving’ with it is best. It’s then a waiting game. Usually the condition will begin to reduce in 1-2 weeks of it’s own accord and you simply have to wait for this. Exercising on an inflamed bursa is not going to help it heal.
Immediate management protocols can also include an oral anti-inflammatory to manage the swelling and any pain that may be associated with the symptoms. The first thing to do is to rule out any involvement of infection. If a bursa is infected or caused from an infection, antibiotics and medication is employed to manage the infection and ensure it doesn’t spread through the rest of the arm. In this case redness and pain with movement would certainly be an indication.
If there is no infection and the bursa involves some pain with palpation, using an elbow pad and avoiding putting pressure on the bursa is primary. If movement aggravates the condition then minimising elbow movement would also be prescribed. But essentially it is a waiting game.
If the condition continues for 3-4 weeks, other measures involving administering corticosteroidal injections may be prescribed. However the effective of this approach can be minimal and some people describe no alleviation of symptoms with this application. In this instance, some doctors will promote aspirating the bursa – effectively draining the fluid from the bursa not only to alleviate symptoms but also to take a sample of the fluid for further investigation of possible infection. Draining the fluid does not necessarily help the bursa to recover. If the bursa has been inflamed from impact or pressure, the fluid will refill even after drainig the bursa. This course of action should only be considered after prolonged inflammation of over 2 weeks and only to determine the cause and reduce acute symptoms if they are present.
It is also common for people who experience these bursas regularly to seek x-rays to determine if a spur or bony protuberance is causing the irritation. If this is the case then it may be prudent to seek surgical intervention to remove the spur to avoid further aggravation in the future. Recovery is swift and mobility is not impaired usually after this surgery. Recovery is often within 1-2 weeks.
SO it’s a minor inconvenience to deal with these types of bursas and the appearance of them is usually the most difficult thing to deal with. Often pain with them is more discomfort (excluding the presence of infection) and annoyance when you accidently lean into the elbow to administer a good gluteus medius massage. But being patient with the bursa and being kind to it usually results in it’s decrease and natural resolution.
But if you think that this week is a good week to come in and get a softer/gentler treatment because I am unable to use my R elbow – think again – I’m all about creative solutions.