Bursite do Olecrano
Patients › Elbow
Olecranon bursitis — causes, symptoms, and when to seek urgent medical attention for infection.
O que você está sentindo
Provavelmente, você nota um inchaço doloroso na ponta do cotovelo. Esse inchaço é causado pelo acúmulo de fluido na bursa, uma pequena bolsa preenchida por fluido que amorteciona o seu osso. A área pode ficar sensível ao toque. Você também pode sentir dor, especialmente se o inchaço for devido a uma infecção ou se o tecido ósseo perdeu o suprimento sanguíneo. Essa combinação de inchaço e dor pode tornar a vida diária desconfortável.
Movimentos simples tornam-se difíceis quando o seu cotovelo está inchado. Você pode ter dificuldade para apoiar o cotovelo em uma mesa ou escrivaninha. Tarefas que exigem dobrar completamente o braço, como alcançar as costas para fechar um sutiã, podem ser dolorosas. Até mesmo enfiar a camisa ou levantar objetos leves pode parecer estranho ou desconfortável. O inchaço pode limitar o quanto você consegue estender ou dobrar o braço.
A dor frequentemente aumenta após você ter usado os braços por um tempo. Ela também pode ser pior à noite, dificultando encontrar uma posição confortável para dormir. Deitar-se do lado afetado coloca pressão direta sobre a bursa inchada, o que pode ser bastante doloroso. Você pode perceber que descansar o braço ajuda a reduzir o desconforto, mas a inatividade prolongada nem sempre resolve o inchaço. Se o inchaço persistir por muito tempo, pode indicar um problema mais complexo que requer atenção específica do seu cirurgião.
O que está realmente acontecendo
O seu cotovelo possui uma pequena bolsa preenchida por fluido chamada bursa olecraniana. Ela fica localizada logo sobre a ponta do osso do cotovelo. Pense nela como um pequeno balão de água que atua como um amortecedor. Ela permite que sua pele deslize suavemente sobre o osso quando você dobra o braço.
Quando essa bolsa se irrita, ela se enche de excesso de fluido. Isso causa inchaço e dor na ponta do cotovelo. Essa condição é chamada de bursite olecraniana. Ela pode ocorrer devido a um impacto súbito, como cair sobre o cotovelo. Também pode surgir devido ao apoio prolongado sobre superfícies duras. Por vezes, uma infecção ou outra doença a desencadeia.
Em alguns casos, o inchaço não desaparece por conta própria. O fluido pode permanecer espesso ou se transformar em tecido cicatricial. Isso é conhecido como bursite crônica. Você pode sentir um caroço duro sob a pele. Isso é chamado de cordão olecraniano. Ele pode fazer com que o cotovelo pareça rígido ou tenso.
Se o inchaço for causado por uma infecção, é chamado de bursite séptica. Seu cirurgião precisa tratar isso rapidamente. Infecções não tratadas podem se espalhar. Em alguns casos, o corpo forma osso extra no tecido mole ao redor do cotovelo. Isso é chamado de ossificação heterotópica. Isso pode limitar o quanto você consegue dobrar o braço. A remoção desse osso extra precocemente geralmente ajuda a recuperar o movimento mais rapidamente.
Seu cirurgião avaliará a causa do inchaço. A maioria dos casos melhora com repouso, gelo e compressão. Você pode não precisar de cirurgia. Se o inchaço continuar voltando, seu cirurgião pode drenar o fluido. Eles também podem usar uma agulha para injetar medicamentos para reduzir o tamanho da bolsa. Isso é chamado de escleroterapia.
Em casos raros, a cirurgia é necessária. Seu cirurgião pode remover toda a bolsa da bursa. Isso é chamado de bursectomia. As técnicas modernas permitem que isso seja feito com pequenas incisões. A recuperação geralmente é rápida. A maioria das pessoas retorna às atividades normais logo em seguida. No entanto, cerca de 11,5% dos pacientes precisam de outro procedimento após a cirurgia. Alguns pacientes com cordões de tecido cicatricial ficam menos satisfeitos com o resultado. Seu cirurgião discutirá a melhor opção para você com base na sua situação específica.
O que podemos fazer a respeito
Começamos com autocuidado e fisioterapia. Você pode repousar o cotovelo e aplicar gelo para reduzir o inchaço. Seu fisioterapeuta irá guiá-lo por meio de movimentos suaves para manter a articulação flexível. Esta abordagem evita procedimentos invasivos. A literatura recente mostra que o manejo não invasivo é frequentemente a melhor etapa inicial para a bursite não séptica. Minimiza os riscos em comparação com injeções ou cirurgia. A maioria dos casos de bursite séptica não complicada resolve-se apenas com manejo empírico. Você deve dar tempo suficiente a este cuidado conservador para que surta efeito antes de considerar opções mais agressivas.
Se a dor persistir, seu cirurgião pode discutir o manejo médico. Para infecções bacterianas, os antibióticos são o tratamento principal. Em alguns casos de bursite recorrente que não respondem ao tratamento padrão, seu cirurgião pode sugerir escleroterapia com doxiciclina intrabursal. Isso envolve injetar uma solução na bursa para encolher a bolsa. É uma alternativa eficaz à cirurgia para casos teimosos. Para bursite não infecciosa crônica ou recorrente, a ablação hidrotermal é outra opção. Isso utiliza calor entre 50°C e 52°C para tratar a área. Tem menos complicações do que a cirurgia aberta e funciona tão bem quanto. Embora estudos mais antigos tenham apoiado injeções para bursite não séptica, evidências mais recentes destacam efeitos adversos potenciais. Portanto, reservamos as injeções para situações específicas nas quais oferecem benefício claro.
A cirurgia é considerada apenas quando o cuidado conservador falha. Se sua bursite recidir ou não melhorar com medicação e repouso, a excisão cirúrgica pode estar indicada. Este procedimento remove completamente a bursa inflamada. É uma solução confiável para casos recorrentes. Os resultados após a excisão cirúrgica são geralmente bons tanto para a função quanto para a aparência. Em alguns casos selecionados de bursite traumática crônica, a reparação por sutura da bursa é uma alternativa viável à remoção total da bursa. Este método combina benefícios funcionais e estéticos. A desbridamento endoscópico combinado com sutura compressiva é outra opção minimamente invasiva. Permite uma recuperação rápida com dor pós-operatória mínima e baixa taxa de recorrência. Seu cirurgião escolherá a melhor abordagem com base na sua condição e histórico específicos.
O que esperar
Sua perspectiva depende em grande parte da causa do inchaço e de como você o gerencia. Na maioria dos casos de bursite séptica não complicada, seu cirurgião pode tratar a infecção apenas com antibióticos. Nessas situações, nenhuma cirurgia é necessária, e a condição geralmente melhora com os cuidados adequados. Se sua bursite não for causada por uma infecção, evidências recentes indicam que o manejo não invasivo é frequentemente mais seguro e eficaz do que injeções ou cirurgia para o tratamento inicial.
Se você tiver bursite recorrente que não melhora com o tratamento conservador, seu cirurgião pode discutir opções procedimentais. Alguns pacientes submetem-se a um procedimento chamado bursectomia, no qual a bursa inchada é removida. Cerca de 11,5% dos pacientes necessitam de um segundo procedimento após essa cirurgia. Se você tiver alterações teciduais específicas conhecidas como cordões olecranianos, pode ficar menos satisfeito com os resultados da excisão cirúrgica em comparação com aqueles que não possuem cordões.
Em alguns casos, o inchaço pode persistir ou retornar. Se sua bursite voltar repetidamente, isso pode indicar uma causa mais incomum, como um tipo específico de infecção bacteriana. Seu cirurgião provavelmente coletará amostras de tecido para verificar essas causas menos comuns. Para casos crônicos ou recorrentes, técnicas mais recentes, como a ablação hidrotermal (usando calor entre 50°C e 52°C), oferecem uma alternativa segura com menos complicações do que a cirurgia aberta. Outra opção é a desbridamento endoscópico, que envolve mínima invasividade e recuperação rápida com baixa taxa de recorrência.
Embora estudos mais antigos sugerissem que injeções e cirurgia eram resoluções padrão para bursite não séptica, os dados atuais destacam possíveis efeitos adversos dessas abordagens. Portanto, seu cirurgião provavelmente priorizará etapas mais simples e não invasivas primeiro. Se a cirurgia se tornar necessária, métodos modernos, como a bursectomia endoscópica, não mostraram recorrências ou complicações de cicatrização de feridas que exigissem retorno à sala de operações em grupos estudados. Sua recuperação será diferente dependendo do caminho escolhido, mas o objetivo é sempre resolver o inchaço e restaurar o conforto com o tratamento eficaz menos invasivo possível.
Quando procurar ajuda médica
Consulte o seu médico de família se tiver um cotovelo inchado que não melhora com repouso. Procure avaliação especializada se o inchaço persistir por muito tempo, mesmo que esteja saudável. Isto pode indicar uma infeção incomum. Procure ajuda se tiver inchaços recorrentes, pois podem ser necessários exames específicos. É difícil determinar se o inchaço é causado por infeção ou por outras causas. Consulte o seu médico se desenvolver feridas abertas na pele com aspeto de infeção. Faça uma avaliação se sentir dor súbita ou fraqueza no cotovelo. Estes sinais requerem uma avaliação adequada para definir o tratamento mais adequado.
Evidence & references
Overview
- Non-operative treatment of olecranon fracture in patients aged ≥75 years provided excellent functional results at 6 months, without associated complications [1].
- Nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management [2].
- Nontuberculous mycobacterial olecranon bursitis should be considered in any patient with a swollen bursa and protracted course, regardless of immune status [3].
- Intrabursal doxycycline sclerotherapy may be an effective alternative to surgical bursectomy for patients with recurrent olecranon bursitis refractory to conservative management [4].
- Patients who underwent endoscopic olecranon bursectomy experienced no recurrences or wound-healing complications necessitating return to the operating room [5].
- Empirical management of uncomplicated septic olecranon bursitis was found to be effective with no patients requiring bursectomy, whereas 8 of 11 patients in the traditional aspiration group required bursectomy [6].
- More recent literature demonstrates adverse effects of intrabursal injections and surgery compared with noninvasive management for initial treatment of nonseptic olecranon bursitis [7].
- The revision rate after bursectomy for olecranon bursitis was 11.5% [8].
- Hydrothermal ablation at temperatures between 50C and 52C is a safe treatment option for recurrent or chronic olecranon bursitis with fewer complications than open bursectomy and a comparable efficacy [11].
- Patients with olecranon cords were less satisfied after surgical excision compared to those without cords [13].
- Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures [14].
- Endoscopic debridement combined with compression suture for the treatment of aseptic olecranon bursitis has several advantages: simple operation, minimal invasiveness, minimal postoperative pain, rapid recovery, a low recurrence rate, and satisfactory overall efficacy [16].
Anatomy & Pathophysiology
- Posteromedial elbow impingement is a source of disability in overhead throwing athletes [12].
- Boxers are prone to the development of anterior and posterior elbow impingement lesions involving the coronoid and olecranon process [33].
- In boxer's elbow, the lead arm is more vulnerable to impingement lesions than the non-lead arm [33].
- Evaluation and management of elbow injuries in young athletes requires knowledge of immature developing anatomy [25].
Classification
- Non-operative treatment of olecranon fracture in patients aged ≥75 years provided excellent functional results at 6 months, without associated complications [1].
- Nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management [2].
- Nontuberculous mycobacterial olecranon bursitis should be considered in any patient with a swollen bursa and protracted course, regardless of immune status [3].
- Intrabursal doxycycline sclerotherapy may be an effective alternative to surgical bursectomy for patients with recurrent olecranon bursitis refractory to conservative management [4].
- Patients who underwent endoscopic olecranon bursectomy for recalcitrant olecranon bursitis experienced no recurrences or wound-healing complications necessitating return to the operating room [5].
- Empirical management of uncomplicated septic olecranon bursitis was found to be effective with no patients requiring bursectomy, whereas 8 of 11 patients in the traditional aspiration group required bursectomy [6].
- More recent literature demonstrates adverse effects of intrabursal injections and surgery compared with noninvasive management for initial treatment of nonseptic olecranon bursitis [7].
- The revision rate after bursectomy for olecranon bursitis was 11.5% [8].
- Excision has been curative for all lesions of the olecranon bursa, whereas multiple medications have been tried for cutaneous and systemic infections without clear-cut success [9].
- Distinguishing between septic and aseptic olecranon bursitis can be difficult because the physical and laboratory data overlap [10].
- Posteromedial elbow impingement is a source of disability in the overhead throwing athlete [12].
- The first treatment line for olecranon bursitis is conservative, including ice, rest, anti-inflammatory and analgesic drugs and, occasionally, bursal fluid aspiration [15].
- Pyoderma gangrenosum must be considered in the differential diagnosis whenever a patient presents with ulcerative cutaneous lesions that resemble an infectious process such as olecranon bursitis [17].
- The available evidence did not support the central European concept of immediate bursectomy in cases of septic bursitis [22].
Clinical Presentation
- Non-operative treatment of olecranon fracture in patients aged ≥75 years provided excellent functional results at 6 months, without associated complications [1].
- Nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management [2].
- Nontuberculous mycobacterial olecranon bursitis should be considered in any patient with a swollen bursa and protracted course, regardless of immune status [3].
- Empirical management of uncomplicated septic olecranon bursitis was found to be effective with no patients requiring bursectomy, whereas 8 of 11 patients in the traditional aspiration group required bursectomy [6].
- Older studies showed resolution with injections and surgery, but more recent literature demonstrates adverse effects of intrabursal injections and surgery compared with noninvasive management for initial treatment of nonseptic olecranon bursitis [7].
- The revision rate after bursectomy for olecranon bursitis was 11.5% [8].
- Excision has been curative for all lesions of the olecranon bursa, whereas multiple medications have been tried for cutaneous and systemic infections without clear-cut success [9].
- Distinguishing between septic and aseptic olecranon bursitis can be difficult because the physical and laboratory data overlap [10].
- The first treatment line for olecranon bursitis is conservative, including ice, rest, anti-inflammatory and analgesic drugs and, occasionally, bursal fluid aspiration [15].
- PG must be considered in the differential diagnosis whenever a patient presents with ulcerative cutaneous lesions that resemble an infectious process such as olecranon bursitis [17].
- Diagnosis and proper management of the infected bursa and dermatitis have prevented recurrence [31].
- In the rheumatoid patient, septic arthritis of the elbow joint can mimic septic olecranon bursitis, and the fact that the elbow joint may also be involved should be suspected in the rheumatoid patient who has what appears to be a septic olecranon bursitis [34].
Investigations
- Distinguishing between septic and aseptic olecranon bursitis can be difficult because physical and laboratory data overlap [10].
- Nontuberculous mycobacterial olecranon bursitis should be considered in any patient with a swollen bursa and protracted course, regardless of immune status [3].
- Pyoderma gangrenosum must be considered in the differential diagnosis whenever a patient presents with ulcerative cutaneous lesions that resemble an infectious process such as olecranon bursitis [17].
- Early use of MRI and cautious interpretation of posterior elbow palpation signs are crucial parts of the diagnosis of osteochondral injury of the elbow trochlea [21].
Treatment
Non-Operative Management
- Nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management [2].
- Noninvasive management is preferred for the initial treatment of nonseptic olecranon bursitis due to adverse effects associated with intrabursal injections and surgery [7].
- The first treatment line for olecranon bursitis is conservative, including ice, rest, anti-inflammatory and analgesic drugs, and occasionally bursal fluid aspiration [15].
- Empirical management of uncomplicated septic olecranon bursitis without aspiration was effective, with no patients requiring bursectomy [6].
- In a comparison of empirical management versus traditional aspiration for uncomplicated septic olecranon bursitis, 8 of 11 patients in the traditional aspiration group required bursectomy [6].
Surgical and Interventional Management
- Intrabursal doxycycline sclerotherapy may be an effective alternative to surgical bursectomy for patients with recurrent olecranon bursitis refractory to conservative management [4].
- Hydrothermal ablation at temperatures between 50°C and 52°C is a safe treatment option for recurrent or chronic olecranon bursitis, offering fewer complications than open bursectomy and comparable efficacy [11].
- Endoscopic debridement combined with compression suture for recalcitrant aseptic olecranon bursitis offers minimal invasiveness, minimal postoperative pain, rapid recovery, a low recurrence rate, and satisfactory overall efficacy [16].
- Patients undergoing endoscopic olecranon bursectomy for recalcitrant olecranon bursitis experienced no recurrences or wound-healing complications necessitating return to the operating room [5].
- The revision rate after bursectomy for olecranon bursitis is 11.5% [8].
- Excision has been curative for lesions of the olecranon bursa, whereas multiple medications have been tried for cutaneous and systemic infections without clear-cut success [9].
Diagnostic Considerations Relevant to Treatment
- Distinguishing between septic and aseptic olecranon bursitis can be difficult because physical and laboratory data overlap [10].
- Nontuberculous mycobacterial olecranon bursitis should be considered in any patient with a swollen bursa and protracted course, regardless of immune status [3].
Complications
- Non-operative treatment of olecranon fracture in patients aged ≥75 years provided excellent functional results at 6 months without associated complications [1].
- Nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management [2].
- Intrabursal injections and surgery have adverse effects compared with noninvasive management for initial treatment of nonseptic olecranon bursitis [7].
- The revision rate after bursectomy for olecranon bursitis was 11.5% [8].
- Patients with olecranon cords were less satisfied after surgical excision compared to those without cords [13].
- Plating of the olecranon leads to predictable union, though the most common complication was lack of full extension in 39% of patients [19].
Recovery
Non-Operative Management
- Non-surgical management of olecranon bursitis is significantly more effective and safer than surgical management [2].
- More recent literature demonstrates adverse effects of intrabursal injections and surgery compared with noninvasive management for initial treatment of nonseptic olecranon bursitis [7].
- Empirical management of uncomplicated septic olecranon bursitis without aspiration was found to be effective, with no patients requiring bursectomy [6].
- In a comparison group, 8 of 11 patients in the traditional aspiration group required bursectomy for uncomplicated septic olecranon bursitis [6].
- The available evidence did not support the central European concept of immediate bursectomy in cases of septic bursitis [22].
Interventional and Operative Management
- Intrabursal doxycycline sclerotherapy may be an effective alternative to surgical bursectomy for patients with recurrent olecranon bursitis refractory to conservative management [4].
- Hydrothermal ablation at temperatures between 50C and 52C is a safe treatment option for recurrent or chronic olecranon bursitis with fewer complications than open bursectomy and comparable efficacy [11].
- Patients who underwent endoscopic olecranon bursectomy for recalcitrant olecranon bursitis experienced no recurrences or wound-healing complications necessitating return to the operating room [5].
- The revision rate after bursectomy for olecranon bursitis was 11.5% [8].
- Patients with olecranon cords were less satisfied after surgical excision compared to those without cords [13].
- Excision has been curative for all lesions of the olecranon bursa in cases of protothecal olecranon bursitis [9].
Specific Etiologies and Considerations
- Nontuberculous mycobacterial olecranon bursitis should be considered in any patient with a swollen bursa and protracted course, regardless of immune status [3].
Key Evidence
- [L4] Non-operative treatment of olecranon fracture in patients aged ≥75 years provided excellent functional results at 6 months, without associated complications. [1] (10.1016/j.otsr.2017.10.015)
- [L4] Based primarily on level IV evidence, nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management. [2] (10.1007/s00402-014-2088-3)
- [L4] Nontuberculous mycobacterial olecranon bursitis should be considered in any patient with a swollen bursa and protracted course, regardless of immune status. [3] (10.1016/j.jse.2008.07.009)
- [L4] This may be an effective alternative to surgical bursectomy for patients with recurrent olecranon bursitis refractory to conservative management. [4] (10.1016/j.jhsg.2024.03.006)
- [L4] In this population, patients who underwent endoscopic olecranon bursectomy experienced no recurrences or wound-healing complications necessitating return to the operating room. [5] (10.1016/j.asmr.2023.100832)
- [L4] Empirical management of uncomplicated septic olecranon bursitis was found to be effective with no patients requiring bursectomy, whereas 8 of 11 patients in the traditional aspiration group required bursectomy. [6] (10.1016/j.jhsa.2019.06.012)
- [L5] Older studies showed resolution with injections and surgery, but more recent literature demonstrates adverse effects of intrabursal injections and surgery compared with noninvasive management for initial treatment of nonseptic olecranon bursitis. [7] (10.1016/j.jhsa.2021.02.006)
- [L3] The revision rate after bursectomy for olecranon bursitis was 11.5%. [8] (10.1016/j.jse.2020.09.033)
- [Case_report] Excision has been curative for all lesions of the olecranon bursa, whereas multiple medications have been tried for cutaneous and systemic infections without clear-cut success. [9] (10.2106/00004623-198062050-00024)
- [L5] Distinguishing between septic and aseptic olecranon bursitis can be difficult because the physical and laboratory data overlap. [10] (10.1016/j.jse.2015.08.032)
- [L4] Hydrothermal ablation at temperatures between 50C and 52C is a safe treatment option for recurrent or chronic olecranon bursitis with fewer complications than open bursectomy and a comparable efficacy. [11] (10.1016/j.jse.2024.03.021)
- [L4] Posteromedial elbow impingement is a source of disability in the overhead throwing athlete. [12] (10.1016/j.arthro.2011.06.012)
- [L4] Patients with olecranon cords were less satisfied after surgical excision compared to those without cords. [13] (10.1016/j.jse.2015.04.016)
- [L3] Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures with excellent subjective and objective clinical outcome measures. [14] (10.1016/j.otsr.2019.08.019)
- [L4] The first treatment line for olecranon bursitis is conservative, including ice, rest, anti-inflammatory and analgesic drugs and, occasionally, bursal fluid aspiration. [15] (10.1016/j.surge.2012.02.002)
- [L4] Endoscopic debridement combined with compression suture for the treatment of aseptic olecranon bursitis has several advantages: simple operation, minimal invasiveness, minimal postoperative pain, rapid recovery, a low recurrence rate, and satisfactory overall efficacy. [16] (10.1186/s13018-024-05090-3)
- [Case_report] PG must be considered in the differential diagnosis whenever a patient presents with ulcerative cutaneous lesions that resemble an infectious process such as olecranon bursitis. [17] (10.1016/j.jse.2014.06.032)
- [L3] Plating of the olecranon leads to predictable union, though the most common complication was lack of full extension in 39% of patients. [19] (10.1016/j.injury.2016.04.015)
- [Case_report] It also emphasizes the early use of MRI and the cautious interpretation of posterior elbow palpation signs as a crucial part of the diagnosis of this lesion. [21] (10.1016/j.jse.2010.09.015)
- [L1] The available evidence did not support the central European concept of immediate bursectomy in cases of septic bursitis. [22] (10.1007/s00402-013-1882-7)
- [L5] Evaluation and management of elbow injuries in young athletes requires knowledge of the immature developing anatomy, injury pathophysiology, and established treatment algorithms for each diagnosis. [25] (10.1016/j.csm.2010.06.010)
- [L4] Diagnosis and proper management of the infected bursa and dermatitis have prevented recurrence. [31] (10.1016/j.jse.2011.10.013)
- [L4] Boxers are prone to development of anterior and posterior elbow impingement lesions, with the lead arm being more vulnerable. [33] (10.1016/j.jse.2016.09.035)
- [L4] In the rheumatoid patient, septic arthritis of the elbow joint can mimic septic olecranon bursitis, and the fact that the elbow joint may also be involved should be suspected in the rheumatoid patient who has what appears to be a septic olecranon bursitis. [34] (10.2106/00004623-198062060-00022)
References
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