鹰嘴滑囊炎
Patients › Elbow
Olecranon bursitis — causes, symptoms, and when to seek urgent medical attention for infection.
您的感受
您可能会注意到肘尖处有一个肿胀的包块。这种肿胀是由于滑囊内液体积聚所致，滑囊是一个充满液体的小囊，用于缓冲骨骼。该区域按压时可能有压痛感。您可能还会感到疼痛，尤其是当肿胀由感染引起或骨组织失去血液供应时。肿胀与疼痛的组合会使日常生活变得不适。
当肘部肿胀时，简单的动作会变得困难。您可能难以将肘部靠在桌子或书桌上。需要完全弯曲手臂的任务，如伸手到背后扣文胸，可能会引起疼痛。即使是塞衬衫或提起轻物，也可能感觉别扭或不舒服。肿胀会限制您伸直或弯曲手臂的程度。
疼痛往往在使用手臂一段时间后加剧。夜间疼痛也可能加重，使您难以找到舒适的睡眠姿势。侧卧在患侧会对肿胀的滑囊造成直接压迫，这可能非常疼痛。您可能会发现休息手臂有助于减轻不适，但长时间不活动并不总能消除肿胀。如果肿胀持续很长时间，可能表明存在更复杂的问题，需要您的外科医生特别关注。
实际发生了什么
您的肘部有一个充满液体的小囊，称为鹰嘴滑囊。它位于肘骨尖端正上方。可以把它想象成一个微小的水气球，起到缓冲作用。当您弯曲手臂时，它使皮肤能够在骨头上平滑滑动。
当这个囊受到刺激时，会积聚过多的液体。这会导致肘尖肿胀和疼痛。这种情况称为鹰嘴滑囊炎。它可能由突然的撞击引起，例如摔倒时肘部着地。长期倚靠坚硬表面也可能导致此病。有时，感染或其他疾病会诱发此病。
在某些情况下，肿胀不会自行消退。液体可能保持粘稠或转化为瘢痕组织。这称为慢性滑囊炎。您可能会在皮下感觉到一个硬结。这称为鹰嘴索。它可能使肘部感觉僵硬或紧绷。
如果肿胀是由感染引起的，则称为感染性滑囊炎。您的外科医生需要迅速治疗这种情况。未经治疗的感染可能会扩散。在某些情况下，身体会在肘部周围的软组织中形成额外的骨骼。这称为异位骨化。它可能会限制您弯曲手臂的程度。早期切除这些额外的骨骼通常有助于您更快地恢复活动能力。
您的外科医生会检查导致肿胀的原因。大多数病例通过休息、冰敷和加压包扎即可好转。您可能根本不需要手术。如果肿胀反复发作，您的外科医生可能会引流液体。他们还可能使用针头注射药物以缩小滑囊。这称为硬化疗法。
在极少数情况下，需要手术。您的外科医生可能会切除整个滑囊。这称为滑囊切除术。现代技术允许通过小切口进行此手术。恢复通常很快。大多数人在术后不久即可恢复正常活动。然而，约 11.5% 的患者在术后需要再次手术。一些患有瘢痕组织索的患者对结果不太满意。您的外科医生将根据您的具体情况讨论最佳方案。
我们能采取的措施
我们从自我护理和物理治疗开始。您可以休息肘部并冰敷以减轻肿胀。您的物理治疗师将指导您进行轻柔的活动以保持关节灵活。这种方法可避免侵入性操作。最近的文献表明，对于非感染性滑囊炎，非侵入性管理通常是最佳初始步骤。与注射或手术相比，它最大限度地降低了风险。大多数无并发症的感染性滑囊炎仅通过经验性治疗即可消退。在考虑更积极的治疗方案之前，您应给予保守治疗足够的时间以发挥作用。
如果疼痛持续存在，您的外科医生可能会讨论药物治疗。对于细菌感染，抗生素是主要治疗方法。在某些对标准治疗无效的复发性滑囊炎病例中，您的外科医生可能会建议进行滑囊内多西环素硬化治疗。这涉及向滑囊内注射溶液以使其缩小。这是顽固性病例的有效手术替代方案。对于慢性或复发性非感染性滑囊炎，热消融是另一种选择。这使用 50°C 至 52°C 之间的热量来治疗该区域。与开放手术相比，它的并发症更少，且效果相当。虽然较旧的研究支持对非感染性滑囊炎进行注射，但新的证据强调了潜在的不良反应。因此，我们将注射保留在能提供明确益处的特定情况中。
仅在保守治疗失败时才考虑手术。如果您的滑囊炎复发或对药物和休息无改善，则可能需要手术切除。该手术完全移除发炎的滑囊。这是复发性病例的可靠解决方案。手术切除后的结果在功能和外观方面通常都很好。在某些慢性创伤性滑囊炎的选定病例中，滑囊缝合修复是完全移除滑囊的可行替代方案。这种方法结合了功能和美容益处。内镜清创联合加压缝合是另一种微创选择。它允许快速恢复，术后疼痛最小，且复发率低。您的外科医生将根据您的具体状况和病史选择最佳方案。
预期情况
您的预后主要取决于肿胀的原因以及您的管理方式。对于大多数无并发症的感染性滑囊炎，您的外科医生可以仅通过抗生素治疗感染。在这些情况下，不需要手术，只要护理得当，病情通常会好转。如果您的滑囊炎并非由感染引起，最新证据表明，非侵入性治疗通常比注射或手术更安全、更有效，可作为初始治疗手段。
如果您患有复发性滑囊炎且保守治疗无效，您的外科医生可能会讨论介入治疗选项。部分患者会接受滑囊切除术，即切除肿胀的滑囊。约 11.5% 的患者在该手术后需要接受第二次手术。如果您存在称为鹰嘴索（olecranon cords）的特定组织改变，与没有索状改变的患者相比，您对手术切除效果的满意度可能较低。
在某些情况下，肿胀可能会持续存在或复发。如果您的滑囊炎反复复发，这可能提示存在更不寻常的原因，例如特定类型的细菌感染。您的外科医生可能会采集组织样本以排查这些较少见的原因。对于慢性或复发性病例，新技术如水热消融术（使用 50°C 至 52°C 之间的热量）提供了一种并发症少于开放手术的替代方案。另一种选择是内镜下清创术，该方法具有微创性，恢复迅速且复发率低。
虽然较早的研究表明注射和手术是非感染性滑囊炎的标准解决方案，但当前数据突出了这些方法潜在的不良反应。因此，您的外科医生可能会优先采取更简单、非侵入性的步骤。如果确实需要手术，现代方法如内镜下滑囊切除术在研究组中显示无复发或需要再次手术干预的伤口愈合并发症。您的恢复体验会根据所选择的治疗路径而有所不同，但目标始终是以最少侵入性的有效治疗来解决肿胀并恢复舒适。
何时就医
若肘部肿胀经休息后未见改善，请咨询全科医生。若肿胀持续时间较长，即使您身体健康，也应寻求专科医生评估。这可能提示存在不寻常的感染。若出现复发性肿胀，请寻求帮助，因为这可能需要特殊检查。很难判断肿胀是由感染还是其他问题引起的。若皮肤出现类似感染的开放性溃疡，请就医。若肘部突发疼痛或无力，请进行检查。这些症状需要适当评估以确定合适的治疗方案。
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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