Cubital Bursa Injection

Indications and Clinical Considerations

Bursae are formed from synovial sacs that allow easy sliding of muscles and tendons across one another at areas of repeated movement. These synovial sacs are lined with a synovial membrane invested with a network of blood vessels that secrete synovial fluid. Inflammation of the bursa results in an increase in the production of synovial fluid with swelling of the bursal sac. With overuse or misuse, these bursae may become inflamed, enlarged, and, on rare occasions, infected. Although there is significant intrapatient variability as to the number, size, and location of bursae, anatomists have identified a number of clinically relevant bursae, including the cubital bursa. The cubital bursa lies in the anterior aspect of the elbow. It may exist as a single bursal sac or in some patients as a multisegmented series of sacs that may be loculated.

The cubital bursa, which is also known as the bicipitoradial bursa, is vulnerable to injury from both acute trauma and repeated microtrauma. Acute injuries frequently take the form of direct trauma to the anterior aspect of the elbow. Repetitive movements of the elbow, including weight lifting and throwing javelins and baseballs, may result in inflammation and swelling of the cubital bursa ( Fig. 65.1 ). Activities requiring repetitive supination and pronation have also been implicated in the evolution of cubital bursitis. Gout or rheumatoid arthritis rarely may precipitate acute cubital bursitis. If the inflammation of the cubital bursa becomes chronic, calcification of the bursa may occur and the bursa may adhere to adjacent structures ( Fig. 65.2 ).

The patient with cubital bursitis frequently reports pain and swelling with any movement of the elbow. The pain is localized to the cubital area, with referred pain often noted in the forearm and hand. Physical examination reveals point tenderness in the anterior aspect of the elbow over the cubital bursa and swelling of the bursa ( Fig. 65.3 ). Passive extension and resisted elbow flexion reproduce the pain, as does any pressure over the bursa. Plain radiographs of the posterior elbow may reveal calcification of the bursa and associated structures consistent with chronic inflammation. Magnetic resonance imaging and ultrasound imaging may help distinguish between bursitis and other soft-tissue masses in the cubital fossa ( Figs. 65.4 and 65.5 ).