David Clarkson's Elbow

A few weeks back, HBO's lauded series 24/7, which was following the Toronto Maple Leafs in the weeks leading up to the Winter Classic, highlighted a nasty injury suffered by David Clarkson against the Carolina Hurricanes on December 29th. On an awkward body check, Clarkson's elbow split open as can be seen below.

The wound required 18 stitches and a little cleaning up but that didn't stop Clarkson from returning to the ice later in the game. However despite returning and playing in nearly every game since the injury (missed 1/7/14 against the Islanders with a foot injury), Clarkson was placed on injured reserve Friday. Clarkson will miss at least a week.

When asked about the injury, Maple Leafs coach Randy Carlyle said:

"He split his elbow two weeks ago, and it was well along its way to healing, and then it re-opened with a body check and it has been draining here for the past seven or eight days. Doctors made a decision that it wasn't going to be favorable for him to continue playing with that and made a decision to treat it now." 

 So it sounds like Clarkson's elbow was fine but after a body check, the stitches split open, aggravating the injury.. Also since his elbow has been getting drained, it sounds like Clarkson has elbow (olecranon) bursitis.

THE INJURY

Olecranon bursitis is the inflammation of the bursa sac located on the tip of the elbow. Bursitis can occur for a number of reasons but is mostly attributed to a hard blow to the elbow or prolonged pressure at the site.

Bursae are thin, slippery fluid-filled sacs of tissue that are located throughout the body wherever skin, muscles, or tendons need to slide smoothly over the bone. A bursa is lined by synovial membrane (soft tissue) and filled with viscous (synovial) fluid, providing a cushion between the bone and tendons/muscles/skin around a joint. Bursae are crucial because they help reduce friction and allow free movement of the joint.

The olecranon bursa is located between the top of the elbow (olecranon) and the overlying skin. Normally the bursa is flat but when it becomes inflamed, fluid accumulates in the bursa.

A direct blow to the elbow may damage or tear the tissues and blood vessels of the bursa, causing bleeding into the bursa sac which swells. If the bursa is filled with blood, it can cause an inflammatory reaction, causing the walls of the sac to thicken. The thickening and swelling of the bursa sac is what is referred to as bursitis. 

Bursitis causes painful swelling in the area at the tip of the elbow and the area is so tender, it's even tough to rest your elbow on a hard surface. Over time, the bursa sac can fill with fluid (pus) and swell up.

TREATING BURSITIS

After diagnosis of bursitis (usually obvious from physical examination by a doctor), the fluid may be drained to make sure there is no infection. Luckily, bursitis is an injury that usually goes away on its own as the body will absorb the blood over a few weeks. An elbow pad will probably be placed to cushion the elbow and the patient should avoid direct contact to the swollen elbow. Ibuprofen or other anti-inflammatory medications may be used to reduce swelling. 

However, if swelling and pain in the bursa is not responsive over the course of a few weeks, a needle may be inserted to drain the blood and fluid and speed up the healing process. During the draining, a small amount of cortisone can be injected into the bursa to control inflammation. Corticosteroid injections usually work well to relieve pain and swelling as they are a strong anti-inflammatory drug. The doctor will take all steps necessary to avoid infection. 

Clarkson's injury shouldn't be too serious as long as his elbow isn't infected. No surgery is required and Clarkson just needs to rest and hope his elbow's inflammation goes down. The fluid-filled sac isn't a problem unless it causes pain. Still, Clarkson should avoid direct contact to his elbow which is difficult for a player of his nature. This probably explains why the Leafs and their doctors are recommending he stay and rest and recover this week.