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Excision of the bursa of the elbow joint is a rather complicated orthopedic procedure, which is performed by a traumatologist. The operation to remove the bursa of a joint is called a bursectomy.
A bursectomy is a surgical procedure used to remove the bursa, which is the cushion cushion that is embedded in the structure of the joint.
Bursae are filled with synovial fluid that lubricates the joints. They serve as friction points between bones and surrounding muscles, ligaments, tendons, and skin. One of the largest bursas in the body, located between the kneecap and the skin, is only a few millimeters and about four centimeters in diameter. The main function of these structures is to provide cushion function during movement. Bursae are fluid-filled sacs near a joint that help them work smoothly and without friction.
During injury or conditions such as rheumatoid arthritis, the synovial membrane of the bursa becomes inflamed due to excess production of synovial fluid, leading to a condition known as bursitis. Usually affecting the knees, elbows, hips, and shoulders, it causes pain and limited movement. The condition can also affect the heel bones and the base of the thumbs.
Excision of the bursa of the elbow joint is usually performed in orthopedic clinics and on an outpatient basis.
Anatomy of Education
The elbow joint is the joint that connects the distal arm to the forearm. It is marked on the upper limb by the medial and lateral epicondyle and olecranon. Structurally, the joint is classified as a synovial joint and functionally as a ball and socket joint.
It consists of two separate articulations: the trochlear notch of the ulna and humerus, and the head of the radius and humerus.
Like all synovial joints, the elbow joint has a capsule that encloses the joint. This formation itself is strong and fibrous, strengthening the joint. The articular capsule is thickened medially and laterally, forming collateral ligaments that stabilize flexion and extension of the arm.
The bursa is a membranous sac filled with synovial fluid. It acts to cushion the moving parts of the joint, preventing degenerative damage. There are many bursae in the elbow, but only a few are of clinical significance: Intratendinous – located inside the triceps tendon of the shoulder, Subtendinous – between the olecranon and the triceps tendon of the shoulder, reducing friction between the two structures when stretching and flexing the arm, Subcutaneous – between the olecranon and overlying connective tissue
Indications for the operation
Patients diagnosed with elbow bursitis are usually advised to take anti-inflammatory drugs to manage their conditions. However, when the condition worsens over time or when the patient no longer responds to medical therapy, bursectomy is recommended to achieve long-term pain relief.
The procedure may also be recommended for athletes with related injuries and for those who have recurrent septic bursitis, in which the inflammation of the bursa is caused by a bacterial infection, causing the synovial membrane to fill with pus that must be constantly removed. A doctor may advise removing the bursa completely to make sure the infection does not spread or recur.
The bursa helps soft tissues, such as muscles and tendons, move smoothly over the bony areas of the joint. The bursa can be damaged by irritation, overuse, trauma, or infection, which can make basic movement painful. Pain can interfere with daily activities.
Most bursa injuries will improve with conservative treatment, such as temporary restriction of certain activities, medications, and physical therapy.
Preparation for manipulation
Before the procedure, depending on the indications, additional laboratory and instrumental studies may be carried out: blood test, X-ray, MRI scan, ultrasound diagnostics.
Talk to your doctor about any medications, herbs, or supplements the patient is taking. You may need to stop taking certain medications a week before your procedure.
Your doctor may recommend that you stop eating and drinking the night before your procedure. The type of anesthesia used depends on the joint affected and the extent of its effect.
How is the procedure performed?
In most cases, the affected joint is anesthetized using local anesthesia, and it is not necessary to put the patient into drug sleep. If the doctor determines that the affected joint needs drainage, a small incision is made and the bursa is opened. A small tube is inserted and kept in the bursa for several days to remove fluid. To prevent infection, antibiotic therapy is also prescribed at the same time.
In cases where draining the fluid does not provide relief, the doctor may decide to remove the bursa completely. This is especially important if movement is severely restricted and the patient is in debilitating pain.
The surgeon in this case makes an incision and removes the thickened bursa. However, there are a few cases where the surgeon decides to remove only part of the bursa and leave a small portion intact to maintain lubrication and reduce friction. If so, chances are the bursa will return to normal size. The incision is then closed with sutures. A modified version, called arthroscopic bursectomy, is performed on patients diagnosed with bursa inflammation in the hip joint.
The surgeon makes an incision in the hip area and inserts a small camera to guide their instruments towards the bursa. Special surgical instruments are then used to drain the excess fluid. In some cases, a complete excision of the bursa from the surrounding muscles and tissues is performed. The incision is then closed.
Potential risks and complications
Problems with the procedure are rare, but all procedures carry some risk. The following potential problems may arise:
- excessive bleeding;
- infection;
- the formation of blood clots;
- damage to blood vessels or nerves;
Before the procedure, you should talk with your doctor about ways to manage factors that can increase your risk of complications, such as smoking, drinking alcohol, and chronic diseases such as diabetes or obesity.
Excision of the elbow bursa can lead to infection at the incision site, which can be prevented by antibiotics. If left untreated, or antibiotic therapy fails, the infection can lead to skin necrosis.
Patients should also follow the prescribed rest period a few weeks after the procedure. Otherwise, healing will be slow, and there will be a possibility of recurrence of the pathological condition. There is a possible limitation of normal mobility that the patient will experience after a bursectomy. For some patients, this complication may even be permanent. In some cases, patients report developing symptoms of joint arthritis after bursectomy.
After operation
The procedure can take from 30 minutes to 2 hours. The duration of the procedure will depend on the location of the bursa. Anesthesia prevents pain during surgery. After the operation, as the area heals, the patient will feel some discomfort. Discomfort after the procedure can be managed with medication. Immediately after the procedure, the staff will monitor breathing, heart rate and blood pressure. An ice pack will be applied to help control swelling in the joint.
It will take several days for the incisions to heal, but full joint recovery takes several weeks. Joint movement may be limited for the first few weeks. The patient will be able to gradually return to normal activity levels. The doctor will also provide exercises and movements to help restore the joint to work properly.
Seek medical attention if you have any of the following symptoms: signs of infection, including fever or chills; redness, swelling, increased pain, excessive bleeding, or any discharge from the incision; persistent nausea or vomiting; pain that cannot be controlled with medication numbness or weakness in the affected joint or muscle, new or unexpected symptoms.
The procedure is considered safe and minimally invasive. Most affected joints heal without any major complications. Patients are advised to rest for a few weeks to facilitate healing, making sure the affected area is used as little as possible. Pain relievers and anti-inflammatory drugs may be prescribed to reduce discomfort. Physical therapy after surgery can be helpful in stimulating the recovery of affected joints and restoring their strength. In most cases, patients can achieve long-term pain relief as well as regain mobility in the affected joints.