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Medical Forum / General / General / February 2004QUESTION ABOUT AN ELBOW
About a month ago, i slipped and fell on ice....ouch now, a month later....the soreness has gone, and even on the day of my fall to now, i have full range of motion. i can even still go to the gym and grab a bar with my right hand (its the right elbow) and hold my weight....but i have this swelling....i wander what i should do. > About a month ago, i slipped and fell on ice....ouch > [quoted text clipped - 5 lines] > > i have this swelling....i wander what i should do. You may have an olecranon bursitis from the trauma. It's a swelling in the bursa around the elbow joint which can occur from chronic inflammation due to the blow to the elbow. If it's not hot, red, or painful, you don't have to do anything. If it bothers you, see an orthopedist. It may require drainage. HMc > If it's not hot, red, or painful, you don't have to do anything. If it > bothers you, see an orthopedist. It may require drainage. Um, yeah...an orthopedic surgeon (if you're into major-league overkill and high-copays) or any primary care physician. > > If it's not hot, red, or painful, you don't have to do anything. If it > > bothers you, see an orthopedist. It may require drainage. > > Um, yeah...an orthopedic surgeon (if you're into major-league overkill > and high-copays) or any primary care physician. Um, yeah...right...I'm going to let a family practicioner excise my olecranon bursa, or make the determination as to when that's necessary. HMc > Um, yeah...right...I'm going to let a family practicioner excise my > olecranon bursa, or make the determination as to when that's necessary. Sounds like you're pretty ignorant about what F.P.'s do. Visit http://www.familydoctor.org for more info. > Sounds like you're pretty ignorant about what F.P.'s do. Visit > http://www.familydoctor.org for more info. A better site for general info on olecranon bursitis (now, remember that we're all just *assuming* that's what you have since you haven't seen a doctor) here: http://orthopedics.about.com/cs/elbow/a/olecranonbursa.htm > > Um, yeah...right...I'm going to let a family practicioner excise my > > olecranon bursa, or make the determination as to when that's necessary. > > Sounds like you're pretty ignorant about what F.P.'s do. Visit > http://www.familydoctor.org for more info. Actually, I've spent many years observing the scope of practice of family practicioners, and the consequences of stepping outside their skill or knowledge set. I've seen it many times and I have even testified in court to it. Co-pay or not, most patients will be better served by having their specialty problems addressed by a specialist. Having said all of that, I'll backtrack and agree that non-septic olecranon bursitis is no big deal, and, to be honest, many family practicioners could probably handle that. HMc > Co-pay or not, most patients will be better served by having their > specialty problems addressed by a specialist. Key word, my friend: "specialty problems." Trouble is, lots of people think they need an ENT for their earaches, a pulmonologist for their cough, an allergist for their runny nose, an dermatologist for their pimples, an orthopedist for their sore back, a neurologist for their headaches...well, you get the picture. Then they'll turn around and berate medical doctors for not treating them "as a whole person". Sad, but true in far too many cases. This isn't about F.P.s "protecting their turf"; it's about the appropriate utilization of limited and expensive medical resources, and delivering routine care in a timely and personal manner. Do some F.P.s "step outside their skills"? I'm sure they do. Show me one profession that doesn't have its bad apples. > Having said all of that, I'll backtrack and agree that non-septic olecranon > bursitis is no big deal, and, to be honest, many family practicioners could > probably handle that. Thanks for being honest. > > Co-pay or not, most patients will be better served by having their > > specialty problems addressed by a specialist. [quoted text clipped - 5 lines] > headaches...well, you get the picture. Then they'll turn around and > berate medical doctors for not treating them "as a whole person". I agree that the definition of "specialty problems" can be a tricky little sucker. > This isn't about F.P.s "protecting their turf"; it's about the > appropriate utilization of limited and expensive medical resources, and > delivering routine care in a timely and personal manner. No, I'm not talking about turf protection either. I think that the most important thing is making sure the patient gets the best care, the most appropriate care for the problem at hand. We all have to be cognizant of appropriate utilization of limited and expensive medical resources. The problem is in delivering the best care with that concept in mind. It would be unfortunate to not give the best care possible in the name of saving the system money. I acknowledge that it can be a fine line to walk, FP's trying to avoid unnecessary consultation vs. "stepping outside their skills". I see both sides of that coin often enough to make me sympathetic to that pressure, but as a surgeon, I would much rather consult on a patient unnecessarily than be called in at the 11th hour to deal with a problem that has now become an emergency. E.G, the closed loop small bowel obstruction that I consulted on and operated on yesterday who had been in the hospital for 36 hours, or the ruptured ectopic that had been at another hospital for 12 hours, with my emergent consultation obtained yesterday after she finally went into shock. And that was just yesterday. I don't really mean to pick on primary care, since I know that you can provide many cases of surgical misadventures too, but these very recent experiences color my participation in this thread. > Do some F.P.s "step outside their skills"? I'm sure they do. Show me > one profession that doesn't have its bad apples. I agree with this, but since "primary care" is just that, *primary*, there is greater pressure on those doctors to triage appropriately and therefore probably a greater tendency to err in obtaining appropriate/timely consultation. This is not meant as a criticism, just an observation of 20 years of evolution of our health care system. HMc > Actually, I've spent many years observing the scope of practice of family > practicioners, and the consequences of stepping outside their skill or [quoted text clipped - 5 lines] > bursitis is no big deal, and, to be honest, many family practicioners could > probably handle that. As septic spaces go, septic olecranon bursitis is probably easier for a non-expert to handle than many. The treatment is really just antibiotics and repeated drainage. That drainage can initially be done with a small needle and so is within the competence of many primary care physicians. If the infection persists or doesn't improve, more aggressive drainage or excision of the bursa may be needed and that would be something I'd want an orthopedist or general surgeon to do.  SignatureDavid Rind drind@caregroup.harvard.edu > As septic spaces go, septic olecranon bursitis is probably easier > for a non-expert to handle than many. The treatment is really just [quoted text clipped - 4 lines] > needed and that would be something I'd want an orthopedist or > general surgeon to do. OK. I'll go along with that. HMc Since I do not have insurance, generally what is the cost of this procedure? Of course I guess it makes a difference if i go to a primary care physician or a specialist. A dollar range would be okay. Thanks > About a month ago, i slipped and fell on ice....ouch > [quoted text clipped - 5 lines] > > i have this swelling....i wander what i should do. |
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