Ask the Doctors

Dear Doctor: I played a pretty rough game of tennis a few weeks ago and developed an ache in my right elbow that turned out to be bursitis. What can I do to ease the pain?

Dear Reader: Our skeletons are marvels of mechanical engineering. They create a scaffold for our muscles, skin and circulatory system, shelter our inner organs, and provide the leverage that makes it possible for us to move about. Wherever our bones meet, particularly in our joints, tiny fluid-filled sacs known as bursa act as cushions. They allow bones and connective tissue to glide easily over one another with minimal friction.

When injury, repetitive movement or sustained pressure causes one or more bursa to become inflamed, the resulting pain and tenderness are characteristic of a condition known as bursitis. Age can play a role in bursitis, as can rheumatoid arthritis. The pain arises when an injured bursa fills with excess fluid and then presses against surrounding tissues and nerves.

The most common locations for bursitis are the hip, knee, shoulder and, as you have discovered, the elbow. The condition is diagnosed via a physical examination of the area, and tests such as an X-ray or an MRI. When a physician suspects that infection may play a role in bursitis, she or he will take some fluid from the affected area for testing.

Since we're not sure what treatment you may have already received, we'll run down our approach with our patients. We begin by addressing the underlying cause, which is inflammation. Rest is important. Bursitis can be brought on by a specific activity, such as tennis for bursitis in the elbow, or throwing a ball or lifting a toddler for bursitis in the shoulder. We recommend that our patients refrain from the particular action until the condition has cleared up.

Anti-inflammatory medications such as aspirin and ibuprofen will help alleviate swelling and pain. If necessary, more powerful anti-inflammatories are available by prescription. Ice compresses applied for 15 to 20 minutes every four to six hours, for three to five days, can also be quite effective in managing the swelling and pain.

Less frequently, it becomes necessary to drain the excess fluid from the bursa with a needle and syringe, a procedure known as aspiration. If we suspect infection rather than injury plays a role, we will send the fluid out for analysis.

In many cases, bursitis will resolve itself over the course of a few weeks or, perhaps, months. In some instances, though, the pain may be persistent. When patients don't get relief from rest, icing and anti-inflammatories, the next step can be a cortisone injection into the site. Cortisone usually provides speedy relief from pain and can be targeted to a specific location.

We have found that gradually adding a gentle stretching program and some easy strengthening exercises can aid recovery. An elbow band, which reduces the pressure of the muscles in the forearm, can help with pain. Your family doctor will be able to help you with all of these.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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