Bursitis is an inflammation of the articular sac. Most often this disease is subject to the knees, elbows, ankles and wrist joints. The anatomical features of the elbow joint make it particularly vulnerable to similar pathologies.
Causes of disease
The elbow joint is not protected by fatty tissue or muscles, while it has a large load. This is one of the reasons that ulnar bursitis is the most common form of this pathology. The reasons for its occurrence may be several:
- Injury - damage to the joint and its bag. Occurs when hitting an elbow on a hard surface, falling on an exposed elbow, sprains and sprains. It may be a concomitant disease with more serious injury.
- Infection - can be carried through the bloodstream or spread from neighboring organs. Since the fat layer on the elbow is not pronounced, inflammatory processes on the skin - boils, pyoderma, and others - represent a great danger.
- Arthritis of various etiologies. In the inflammatory process in the joint, it will almost always be accompanied by bursitis.
These include diabetes mellitus, disruptions of immune processes (including those caused by the use of drugs that reduce immunity), metabolic disorders, advanced age and systemic pathologies of connective tissue. Most often there is a combination of several factors.
Mechanism of development and features of the development of elbow bursitis
The mechanism of development of inflammation is reduced to the fact that when the synovial sac is damaged (the Latin name is “bursa”), a greater amount of joint fluid begins to stand out, the joint volume increases, resulting in swelling and tenderness of the joint. At the same time, its mobility is impaired, because excess fluid prevents the movement of bones.
The features of the elbow joint are that it is a complex joint consisting of three separate joints:
- humeral-spleen (the articular surface of the ulnar bone forms a protruding formation, which is commonly called the elbow);
- brachylochevoy;
- proximal radioulnar (provides supination and pronation of the arm - rotation along the longitudinal axis).
Each of these joints has its own synovial bag. Most often, the largest of them is affected - the shoulder joint bag.
Types of bursitis
Bursitis is classified according to several important features. Adrift acute, subacute, recurrent and chronic bursitis. According to the peculiarities of localization - humeral humeral (subcutaneous) bag, humeral and radiopaque (interosseous) bursitis. The most common type of illness is acute shoulder bursitis.
For reasons, bursitis is divided into traumatic, occupational, infectious (specific and non-specific). Traumatic bursitis is caused by mechanical injury of the joint, professional - a chronic load on the arm, intoxication or other harmful factors.
Infectious bursitis is divided into non-specific, which is most often caused by staphylococci or streptococci, and specific, in which the characteristics of the inflammatory process helps to determine the pathogen. Most often it is brucellosis, gonorrhea, syphilis, tuberculosis.
According to the nature of the inflammatory process, serous, purulent, fibrinous and hemorrhagic bursitis is isolated. Serous inflammation can be both an independent disease (with mild trauma) and the initial stage of a more serious pathology.
Purulent bursitis is most often caused by bacteria and tends to spread. For fibrinous characterized by the appearance of fibrin molecules that contribute to the formation of adhesions in the joint. Hemorrhagic - bursitis with the release of blood, often causes complications.
Features purulent bursitis
Purulent bursitis is a disease caused by bacteria. Most often, its direct cause is the penetration of bacteria from foci of infection on the skin. The source of infection can be a furuncle or erysipelas on the skin near the elbow. Such bursitis is called secondary. The primary disease occurs when a penetrating wound of the elbow and infection in the articular bag.
The peculiarity of the pathological process lies in the fact that its signs are especially pronounced, often common symptoms occur. The elbow, part of the shoulder and forearm next to it are swollen, the skin is stretched, it looks bright red. The mobility of the joint is reduced, there is marked pain when moving, resting on the arm, at rest. The temperature rises, the symptoms of general intoxication of the patient are pronounced - headache, nausea, poor health.
Among the complications that this disease can cause are inflammatory processes in other parts of the joint (purulent arthritis, synovitis), bone lesions (osteomyelitis), the spread of infection beyond the articular cavity (myositis, neuritis, tenosynovitis). The most serious complication is sepsis.
Characteristic symptoms
Symptoms may vary depending on the form of inflammation. Nevertheless, there are always classic signs of inflammation - pain in the joint, swelling, a violation of flexion. Their severity is changeable.
Acute serous, or hemorrhagic, bursitis develops after injury. It is characterized by a noticeable increase in the volume of the joint in the eye, the appearance of protrusion on the extensor surface of the arm, redness of the skin. The pain is practically absent at rest, but appears during joint palpation and movement. Mobility is limited - extension of the joint is impossible. The general condition does not suffer.
Chronic serous bursitis is manifested by the same symptoms, but in an erased form - pain periodically occurs when moving, often there is a feeling of joint fatigue, discomfort, tension, but not pain.
Mobility without an exacerbation can be almost normal, during an exacerbation there is a feeling of resistance to movement.
Chronic fibrinous bursitis is characterized by adhesions in the joint area. The pain in it can be expressed very weakly, the general condition does not suffer (as with any chronic bursitis), there are no external changes or they are minor. In this case, violations of the mobility of the joint come to the fore. Their severity can be so significant that the mobility of the elbow is completely lost.
The picture of purulent inflammation was mentioned above - it is characterized by bright clinical signs, a pronounced deterioration of the general condition. If bursitis becomes chronic, then the probability of formation of adhesions in the joint and loss of mobility.
Diagnostics
To establish the diagnosis, the doctor examines the patient's elbow, collects a history (it is important to have injuries in recent times or chronic foci of infection). A series of studies are then assigned.
First of all, a joint X-ray is performed - it allows to exclude fractures and fractures of the limb bones.
The next stage - ultrasound. This examination will show that the cartilage, ligaments and tendons of the joint are not damaged, it will also indicate an increase in the thickness of the articular sac and the amount of fluid in the joint. The puncture of the joint puts the point in the diagnosis - it shows excessive fluid excretion and allows you to determine the type of inflammation.
If pus is present in the articular fluid, an additional analysis is done - sowing discharge to identify the causative agent. Immediately, it is tested for sensitivity to antibiotics (antibiogram) in order to prescribe the most effective drug. In controversial cases, an MRI or CT scan of the elbow is required.
ICD code 10
In the international classification of diseases, the elbow bursitis has the code M70.2 if the shoulder-joint joint is affected, and M70.3 with other lesions. ICD-10 refers it to diseases of soft tissues, which are caused by excessive load.
Drug treatment of elbow bursitis
Treatment of the disease is based primarily on tight bandaging and ensuring rest (if it is serous bursitis). But in the case of purulent inflammation can not do without drugs.
Medicines
From etiotropic therapy prescribed antibiotics. The choice of the drug depends on the results of the antibiogram.
They are prescribed only for purulent bursitis, in other cases there is no need for antibiotics. Taken in pills, in severe condition - in the form of intramuscular injections. The joint is also washed with antibiotic solutions and drained.
From pathogenetic agents prescribe anti-inflammatory drugs (NSAIDs). They are used for any type of bursitis to reduce the severity of the inflammatory process. In cases of severe inflammation, corticosteroids are administered into the joint cavity.
Additionally, medical puncture procedures with removal of excess fluid, washing and drainage of the joint, physiotherapy can be prescribed.
Ointment
Ointments are used for relatively easy course of the disease. They prescribe anti-inflammatory drugs (Dolobene, Finalgel), which need to be applied several times a day. This can be done at home. You can not use the warming ointment (Kapsikam) - they increase the inflammatory process.
Home treatment
At home, only a relatively mild form can be treated - serous bursitis. For this purpose, anti-inflammatory ointments, tight fixation of the joint with an elastic bandage or wearing an orthosis, as well as a strict limitation of the load are used. Any sudden movements, lifting weights, physical exercises that affect the sore hand, should be completely excluded.
As you improve, you can gradually increase the amount of movement. Pain should serve as a guideline - if it doesn’t bother, it means that the load was adequate. You can perform simple exercises to train a sore arm, but always with a brace or elastic bandage. It should start with flexion-extension and rotation. Return to the usual rhythm of life can be after the disappearance of symptoms.
Preventive measures
Completely avoid bursitis is impossible. Nevertheless, a number of measures can be taken to reduce the likelihood of its occurrence. Care should be taken to avoid elbow injury. Athletes, even amateurs, need to train in elbow pads to distribute the load and avoid injury to the joint.
For people working in hazardous conditions where there is a risk of injury to the hand, it is important to follow safety precautions - use protective clothing, use equipment properly, and have regular medical check-ups.
In order to prevent purulent bursitis, personal hygiene, the elimination of foci of infection in the body, and the treatment of skin purulent lesions that can cause pathology are required. It is unacceptable to press acne that occurs on the elbows - it is possible the spread of the infection deep into and the development of bursitis.
