• Student’s elbow – clinically referred to as Olecranon Bursitis This is a condition characterised by pain, redness and swelling around the olecranon, caused by inflammation of the elbow’s bursa.
• Bursitis normally develops as a result either of a single injury to the elbow (e.g., a hard blow to the tip of the elbow), or more commonly due to repeated minor injuries and if a person’s job involves a repetitive movement, also the possibility of developing the condition is more common as a person gets older.
• Olecranon bursitis is a condition in which there is an inflammation of the bursa overlying the olecranon process at the proximal aspect of the ulna. The superficial location of the bursa, namely between the ulna and the skin is susceptible to inflammation from a variety of mechanisms, primarily either acute or repetitive trauma. It is also possible that the inflammation is due to infection, called septic bursitis.
Causes of Students’ elbow
• There is no predisposition for race or sex. Olecranon bursitis occurs with children and adults. Long-term hemodialysis treatment, uremia, or a mechanical factor (like resting the posterior elbow during a hemodialysis treatment) can be a cause of inflammation.
• This condition can be caused by acute injuries (trauma) during sports activities because they can include any action that involves direct trauma to the posterior elbow. For example, falling onto a hard floor, etc.
Other common causes of olecranon bursitis, which are not related to sports activities, include repetitive microtrauma, like rubbing constantly the elbow against a table during writing.
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| Students' Elbow |
Symptoms of Students’ elbow
• Stiffness
• Achy feeling
• Pain with movement or pressure
• Red and swollen appearance
Clinical presentation of Students Elbow
• Bursal inflammation’s most classic finding is a swelling, at the posterior elbow. This swelling is clearly marked off by its appearance as a goose egg over the olecranon process.
• There may be a tenderness for palpation at the affected site.
• The Range of motion (ROM) of the affected elbow is usually normal but now and then it is possible that the end-range of elbow flexion is slightly limited due to pain.
• Patients suffering from systematic inflammatory processes (like rheumatoid arthritis) or crystal – deposition disease (like gout or pseudogout) may reveal evidence of focal inflammation at other sites.
Non Surgical Treatment
• Bursal aspiration alone, with or without compressive dressings;
• Conservative approach;
• Nonsteroidal anti-inflammatory drugs for 10 to 14 days;
• Corticosteroid injections alone, after aspiration;
• A “blood patch” injection;
• The temporary 3-day use of a percutaneous-intrabursal drainage catheter;
Surgical treatment of Students’ elbow
• Sometimes the bursa will need to be drained. This process is called aspiration. After numbing the area with a local anesthetic, a healthcare provider will inject a needle into the inflamed bursa to remove the fluid.
• In rare cases, the bursa may need to be surgically removed. Doctors tend to avoid this as the incision can become infected. But if your bursitis has been a chronic issue for 6 to 12 months, your doctor may recommend surgery.
Physiotherapy management of Students’ elbow
- Rice Protocol
1. Rest
• A good place to start when trying to heal your bursitis is to rest the joint.• Bursitis often happens to joints that are used for frequent repetitive motions. You can develop this condition because of sports like tennis or golf.
• Elbow bursitis can also be caused by long periods of leaning on your elbows, or after a trauma, like falling on your elbow.
• If a behavior or habitual action caused your inflammation, the best thing you can do is to avoid this action. If you can avoid irritating the bursa, often bursitis will go away on its own.
2. Ice
• Icing the elbow for the first 48 hours after symptoms begin can reduce swelling.• The cold helps to reduce blood flow to the area, which can decrease inflammation. Cold therapy can also help temporarily relieve pain by decreasing nerve activity.
• Never apply ice directly to your elbow, as this can cause injury to the skin. Instead, try wrapping the ice in a towel. Apply ice to the skin in short 15- to 20-minute periods to prevent nerve damage.
3. Heat
• Try applying heat or taking a warm bath. Heat helps to improve circulation, which can help decrease stiffness. Heat can also work to soothe your discomfort.• It’s important that your heat therapy is warm rather than hot, so you can avoid the risk of burning yourself.
• Treating with heat and cold can be effective for bursitis and many other types of inflammation. But if either causes you more pain or swelling, stop the treatment immediately.
4. Activity change
• It’s good to avoid activities that apply pressure or stress on the elbow, including some types of contact sports, exercise sports, and heavy lifting.• If a repetitive action caused your flare-up, try your best to avoid those actions. If you must engage in it, try taking regular rest breaks or alternate that action with others. Talk to your doctor about what alternatives you could do instead.
5. OTC pain relievers
• Take over-the-counter (OTC) pain relievers to reduce pain and inflammation.• Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely available anti-inflammatory medications that do not require a prescription. These include aspirin, ibuprofen (like Advil or Motrin), and naproxen (Aleve).
There are also topical formulations that you can apply to the skin that may help with pain, such as a cream that contains capsaicin.
6. Elbow pad
• Use an elbow pad to cushion your elbow while you sit, work, or sleep.Not only does the padding help you to avoid hitting the elbow, but it also wraps the area around the elbow.
• The wrapping causes compression and traps heat. Compression can help reduce swelling, and warmth can decrease stiffness.
7. Streching Exercises
A. Flexion stretch
B. Extension stretch
C. Pronation and supination stretches
D. Hand flips
8. PHONOPHORESIS
• honophoresis is the use of ultrasound to enhance the delivery of topically applied drugs. Phonophoresis has been used in an effort to enhance the absorption of topically applied analgesics and anti-inflammatory agents through the therapeutic application of ultrasound.9. ELECTRICAL STIMULATION
- Electrical stimulation or neuromuscular electrical stimulation (NMES) is a technique used to elicit a muscle contraction using electrical impulses. Electrodes, controlled by a unit, are placed on the skin over a predetermined area.
- The electrical current is then sent from the unit to the electrodes and delivered into the muscle causing a contraction. Decrease pain, Muscle re-education, and Strengthening Increase range of motion Increase circulation Decrease spasticity, Reduce edema, Decrease inflammation, Improve overall function.
- When the patient shows no response to conservative treatment and his condition deteriorates, then surgery may be indicated. When a patient undergoes a bursal excision (bursectomy), there might be a recommendation for physical therapy after the operation for regaining or maintaining the ROM and strength of the elbow.
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