Elbow effusion

General information

The fluid in the elbow joint is necessary for normal elbow movement. However, an increase or decrease in its amount causes “failures” in the elbow’s work. This symptom is accompanied by stiffness and painful sensations. In some cases, there is an increase in temperature, general weakness, and characteristic snapping. At the first signs of fluid accumulation in the joints, it is necessary to consult a doctor. The symptom often signals diseases, which, as a rule, lead to irreversible changes.

Anatomical structure of the elbow joint

The elbow is a mobile joint of humerus, radius and ulna. This joint is complex because it comprises three smaller ones enclosed in a single capsule. Following components are distinguished:

• Humeral–ulnar joint. It is formed by a block of the humerus and a section of the ulna. Visually represents a block with surfaces built like a screw. There is a characteristic groove in the form of a screw, as well as a ridge entering the notch of the humerus.
• Humeral-radial joint. Joint between the head of the condyle of the humerus and the fossa of the radius. A spherical joint with motion in two axes. Motion in the other directions is limited by its connection to the ulna.
• Proximal radial-ulnar joint. This joint is the connection of the radius with the ulnar notch, as well as with the articular circumferential articulation. It is characterized by a cylindrical shape. Responsible for flexion, extension, and rotation.

All three joints are surrounded by a single periarticular bag and synovial membrane. The latter contains a thick mass of synovial fluid. Its composition is identical to blood plasma. The main component is hyaluronic acid.

A fluid deficiency within the synovial membrane results in a specific creaking sound. Friction leads to the gradual thinning of cartilage and accelerates its destruction. The accumulation of fluid in the cavity also has a negative effect on well-being. It leads to stretching of the articular bag and difficulty of movement in the joint.

Specific pathologies that lead to synovial fluid accumulation include:

1. Bursitis. The course of the inflammatory process in the articular bag leads to the appearance of exudate. Separate serous, hemorrhagic, purulent bursitis. Pathology is most often found in professional athletes.
2. Synovitis. Represents inflammation of the synovial membrane, in which fluid accumulates inside the lined cavity. It affects places where tendons connect to bones, sometimes to large muscles.

Pathologies can be both an independent phenomenon and a consequence of other diseases that negatively affect the state of the synovial bag and the elbow joint as a whole. This article considers in detail diseases associated with fluid accumulation in the elbow joint cavity.

Causes

Fluid in the elbow is only a symptomatic manifestation. It can be caused by various causes, including trauma, surgery, certain diseases, and metabolic disorders. Identifying the cause of fluid accumulation is important in order to build a therapeutic strategy.

Traumatic effusion

Synovitis and bursitis of the elbow joint are usually associated with traumatic effects on the joint or tendons. The rupture of the periarticular bag leads to bruises, sprains, and dislocations. As a result, blood and serous fluid enter the cavity. Intensive synthesis of synovial mass entails the development of edema. The acute condition leads to severe pain. In the absence of treatment and repeated traumatization, the disease acquires a chronic character. Bursitis can develop not only after an elbow contusion or ligament sprain. The elbow joint is traumatized:

• overweight;
• lifting weights;
• regular, intense exercise.

The risk of developing bursitis after injury is significantly higher in immunocompromised individuals.

Post-surgical

Endoprosthesis of any joint can lead to inflammation. Competent preparation for surgery and following the rehabilitation program significantly reduces the likelihood of complications. However, even after professional surgical intervention, pain, swelling, and restricted mobility are likely to occur. In some cases, lesions of the articular bag are detected as a result of infectious penetration, allergic reaction, or poor blood coagulation.

Other diseases

The development of bursitis can occur in conjunction with other diseases. The most common causes of the condition are as follows:

1. Against the background of rheumatoid arthritis. Systemic disease of unclear etiology, causing lesions of small joints with erosions and destructions. Occurs in a chronic form.
2. Gout. A pathological disorder of purine metabolism (derivatives of uric acid) causes the accumulation of salts. Gouty arthritis provokes painful sensations, swelling, and lividity of the skin.
3. Systemic scleroderma. Autoimmune lesions of the body lead to skin, musculoskeletal system, and internal organs disorders.
4. Purulent inflammation. Purulent fluid in the area of the joint is associated with osteomyelitis, phlegmon, and rupture of a furuncle.
5. Infectious diseases. Prerequisites for developing bursitis are staphylococcus aureus, syphilis, and tuberculosis. 

Metabolic disorders

Fluid in the elbow joint can accumulate due to salt retention in the body. A metabolic disorder in the elbow area may be due to:

• diabetes mellitus or other endocrine pathology;
• pregnancy;
• an unbalanced diet;
• stress or emotional overload;
• menopause;
• lack of exercise;
• alcoholism and drug addiction.

Symptoms

Elbow effusion can cause:

1. Pain. There may be tearing, squeezing, burning, pulling pain.
2. Limitation of mobility. The range of motion of the injured joint is significantly reduced.
3. Swelling. Swelling over the joint after a contusion or in the acute stage can be impressive. In the chronic course, there is mild swelling of the area.
4. Skin discoloration. If fluid has accumulated in the elbow joint, redness, bruising, and skin discoloration are likely.
5. Fluctuating temperature. There is both a warming of the skin in the affected area and an increase in overall body temperature.
6. Deterioration of well-being. The accumulation of fluid in the joint cavity causes weakness and adversely affects performance.

Diagnosis

To make a diagnosis and determine the tactics of treatment requires a comprehensive diagnosis, which will help to establish the causes of development and severity. The following diagnostic techniques are distinguished:

1. Anamnesis and counseling are involved. Peer review is recommended. Rheumatologists, traumatologists, orthopedists, and infectious disease specialists are involved.
2. Radiography. It allows you to obtain information about the state of the musculoskeletal system. In most cases, it does not show the whole picture.
3. MRI and CT scan. For a detailed study of the elbow joint, the doctor may prescribe magnetic resonance imaging or computed tomography.
4. Clinical tests. The number of leukocytes and C-reactive protein determine the general condition and the level of development of the inflammatory process. Reactions to infections and specific joint tests (ACPA, rheumatoid factor, HLA-27B) establish the causes of the disease.

Modern diagnostic methods allow you to make an accurate diagnosis within 2-3 days, proceed to therapy, and minimize the consequences of fluid accumulation in the elbow.

Treatment

Therapy of any joint pathologies is carried out over a long period of time. Treatment methods are selected depending on the main diagnosis. To relieve the patient’s condition, symptoms must be relieved. The elbow joint treatment involves instrumental techniques, pharmacotherapy, and physiotherapeutic procedures.

Fluid puncture

It is indicated in cases of limited arm movement and severe swelling. The method allows you to get rid of excess fluid within 30 minutes. The attending physician disinfects the skin and introduces a syringe into the cavity for subsequent puncture of the effusion. Further observation is required, and if necessary, anti-inflammatory drugs are prescribed. This refers to symptomatic therapy. Without treatment of the underlying cause, fluid accumulation will occur again in 85% of cases.

All these treatment options are available in more than 980 hospitals worldwide (https://doctor.global/results/diseases/elbow-effusion). For example, Arthrocentesis can be performed in 50 clinics across Germany for an approximate price of $1,4K (https://doctor.global/results/europe/germany/all-cities/all-specializations/procedures/arthrocentesis). 

Related procedures

Physiotherapeutic procedures such as physiotherapy are recommended for the treatment of post-traumatic syndrome, relief of autoimmune conditions, and synovitis/bursitis of other etiologies:

1. Plasmolifting. Injections of purified blood plasma stimulate tissue regeneration, control inflammation of mucous membranes, and relieve pain. Both acute and chronic bursitis are treated. Indications include arthritis, gout, rheumatoid arthritis, and Bekhterev’s disease.
2. Laser stimulation increases blood flow in the affected area, relieving pain, limitation of mobility, and swelling.
3. Acupuncture. It allows you to start regenerative processes after mechanical damage or joint disease.
4. Magnet therapy of the affected area. Relieves clinical symptoms and accelerates recovery.

The above methods can be used at once as prescribed by a doctor.