Sunday, July 31, 2011

Bursitis Hip, Knee and Elbow

" can't always get what you want.
But if you try sometimes,
you might find, you get what you need."

                                                                       Rolling Stones

I've heard that the following was a serious question; "Was Paul McCartney in a band before Wings?" 

I 'm afraid, as it's it's been pointed out many times, that those of us who do not understand the past are doomed to repeat it.  With respect to injury, triathletes continually repeat the errors/oversights of those who've raced before us.  With the same poor results and lost time training I might add.

Now that we're smack dab in the middle of the summer, and more and more of us are at the peak of our training year, there will likely be a commensurate increase in sore, aching limbs.  It will be pretty tempting to ignore these "minor aches and pains" or treat them with a little I'm an Ironman liniment, but a wiser choice might be to pause and seek out the cause of this distress.  Is this pain secondary to bursitis or an inflammation of the fluid filled sacs (bursal sacs) that surround or cushion our joints?

Bursitis is a condition that causes these sacs to become irritated or infected heralding pain associated with motion.  If this is diagnosed as infection, prompt intervention by the medical team is important to keep the process localized and (hopefully) minimize it's severity.  As noted in this blog two weeks ago, the patient presenting with joint pain, say an elbow for example, has the potential for this to be arthritic, tendinitis, stress fracture, etc. and the care giver must differentiate between these entities.  If the working diagnosis is bursitis, culling out the infected from non-infected is the next step.  We've previously noted that bursitis of the heel is predominantly an overuse type issue as is the hip.  When considering the knee and elbow, so-called pre-patella bursitis and olecranon bursitis, we generally think of a chronic or low level of trauma keeping the potential for infection on the table.

Symptoms of bursitis might include pain in the vicinity of the joint, an actual swelling of merely a sense of fullness, warmth, and/or redness.  In the hip this is called trochanteric bursitis and is usually found over the bump on the outside of the hip frequently radiating to the thigh.  It's worsened by laying on that side, stairs, or upon standing from the seated position.  The elbow will demonstrate a fluid collection over "the point of the elbow," frequently involving infection.

    In the knee, this has picked up the term "housemaids knee" and occurs after prolonged kneeling, previous injections, kidney disease, etc.  One can actually see the swelling as a pocket or pouch over the front of the knee.  Infection is part of the suspected diagnosis.

Treatment of bursitis usually does not involve surgery and can include compressive dressings and ice, changing ones activity to avoid/lessen the offending stimulus, aspiration and culture to determine presence/absence of infection - primarily in the knee and elbow.  Those determined free of infection may occasionally be candidates for a corticosteroid injection.  That said, if steroids are administered to one that's infected matters can be made much worse!  NSAIDS and antibiotics will commonly be part of the plan.

In short, as in many problems presented in this blog, early diagnosis and treatment with careful follow up give the highest probability for success and return to the age group wars!

Images 2 and 3, Google images.

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