The bursa is a cushion that is present at the back of the elbow. It allows the skin to glide over the bone on movement.
This condition presents as painful swelling at the back of the elbow. The pain and the swelling can vary in intensity and size respectively. Once it occurs, the condition can become recurrent. It can hinder elbow and arm function as resting on the elbow is painful.
It is thought to start with irritation of the bursa. Most commonly by repetitive action such as resting on the elbow. However, it can also occur spontaneously.
How is the diagnosis made?
The diagnosis is made by history and examination. An X-ray may be required looking for a bony spur.
What is the treatment?
Most commonly, the bursa is inflamed. This can be treated with anti-inflammatories and in the majority of cases this resolves the issue. Occasionally, the remnant bursa may remain enlarged and problematic. If this is the case, it can be aspirated but this usually leads to recurrence. Otherwise it can be excised surgically. If surgery is performed, it will involve excising the whole bursa but also the bony spur (if one is present).
The surgery is performed under general anaesthetic as a day case procedure. There will be dressing and bandages but patients can move and use their elbow afterwards. The sutures will be removed at 2 weeks.
Sometimes the bursa may be infected. This may be associated with severe pain and spreading cellulitis (redness). In this case, this can be treated with antibiotics. Occasionally this may require admission to hospital for intravenous (injection) antibiotics and elevation of the arm. In most cases, the infection resolves with this but if the antibiotics fail, an incision and drainage (a cut to let the pus out) may be necessary. This operation is carried out under general anaesthetic
The surgery is performed under general anaesthetic. It may require further surgery 48 hours later for further washout. The wound is usually left open and allowed to heal from inside to out. This will require regular change of dressings. The wound may take a couple of weeks to heal fully.
Risks of Surgery
This surgery carries risks of infection, bleeding, nerve injury, recurrence of the bursa and sinus formation (an opening in the skin with constant discharge).