For centuries, people with physically demanding occupations have been known to be prone to developing large, swollen knees and elbows, especially after a serious bump or bruise. Originally dubbed “miner’s elbow” and “handmaid’s knee”, these conditions are now known to be varieties of bursitis, the inflammation of a bursa, a fluid-filled sac that limits friction between the skin and a joint such as the knee or elbow.
Bursitis affects over 30,000 people each year in the United States, many of whom are plumbers, roofers, or practice some other profession or hobby that places prolonged stress on the knee or elbow. If you have a large, soft knot on your knee or elbow after a bump or fall, you may have bursitis. This in itself is no cause for alarm. About two-thirds of all cases of bursitis are mechanical, resulting solely from some sort of minor or repetitive trauma. These cases typically resolve on their own with rest and protection of the area and only require medical treatment if they cause major inconvenience or discomfort. However, if a case of bursitis is tender, painful, or accompanied by redness or fever, it may be a part of the one third of all cases which are septic, resulting from a bacterial infection.
People with compromised immune systems, such as people with diabetes, rheumatoid arthritis, or HIV, may be more likely to develop septic bursitis. Additionally, cases of bursitis that result from a trauma that caused a cut or lesion on the overlying skin are more likely to be septic. If you suspect you may have septic bursitis, it is best to seek medical treatment. Most cases of septic bursitis can be resolved through conservative treatments such as aspiration and the use of oral antibiotics. However, if these treatments are unsuccessful, the doctor may have to consider surgical intervention in order to avoid serious complications from unchecked infection. In this case, the doctor may perform a bursectomy, the removal of part or all of the bursa, in order to cure the infection. While the surgery does successfully and permanently resolve the majority of cases of septic bursitis, the conventional technique leaves a rather large surgical wound that may heal slowly or result in complications such as tenderness. An alternate technique can be used that allows the surgeon to remove the infected bursa through a much smaller wound around the outer edge of the bursa where the skin is in better condition. Through this technique, which involves the use of an arthroscope, a small fiberoptic lens that can be used to look inside of the bursa, even the most difficult cases of bursitis can be resolved with a minimal risk of complication.
If you notice a large bump on your knee or elbow in the wake of a knock or fall, you may have bursitis. A physically demanding job or hobby puts you at particularly high risk for the condition. However, there is no need to fear. Most cases will resolve with rest and protection and pose no major risk of long term harm. However, if rest and protection don’t resolve the problem or if you notice warmth, tenderness, or fever associated with your bursitis, it is best to seek the advice of an orthopedic surgeon to get you back to work or back on the field as quickly and safely as possible.
John Meade, MD is a physician with OrthoCarolina Monroe.