A Healthy Bet (8) – Poker Elbow

A Healthy Bet (8) – Poker Elbow

As it appeared in Ante Up Magazine – Jun. 2009

By Frank Toscano, M.D.

When Ante Up Magazine asked me to write a health column for a poker magazine (presumably because I wasn’t a good enough poker player to write an actual poker column), they suggested that “Maybe poker players get carpal tunnel or something.” Well, actually, they don’t. But they do get something similar at a different spot.

Author and Ante Up Magazine Columnist, Joe Navarro, cured Phil Hellmuth of one of his most obvious tells, hugging himself when he bluffs. Now Phil plants his elbows on the table rail and covers his lower face and neck with his hands. His tell is gone but he may be trading it for some elbow problems. Let me explain.

If you wiggle the skin overlying the boney tip of your elbow, you’ll notice that the skin is loose and it slides rather nicely in all directions. The same thing happens over your knees, and to a lesser extent, over your hips and shoulders. There is a slippery sac just below the surface of the skin called a bursa that allows this movement to occur. There are places in your body you wouldn’t want loose skin of course. It would be difficult to look cool shuffling poker chips if you had slippery bursas under your fingertips. But having bursas over major joints makes it easier to flex them smoothly.

Like any small dark moist enclosed space in your body, if bacteria can get in, they’re sure to like the accommodations. It turns out that there are plenty of bacteria not very far away living in the folds of the skin you just wiggled in the last paragraph. Add a little bit of microtrauma from leaning on your elbows for 15 straight hours playing poker, and the bacteria can migrate into the bursa and set up shop. The resulting bursitis might be just a little extra fluid in the sac but it can also turn into a rip roaring infection.

If the bursitis is not particularly painful and not red or hot, it’s probably just inflamed and not infected and it will probably resolve itself over time especially if you leave it alone and stop leaning on it. Even a swollen bursa the size of a golf ball can eventually be reabsorbed by the body.

But if it starts to get red, hot and painful or if you’re running a fever, the strategy is different. Now you’ve got a real infection. The physical structure of the bursa makes it difficult for antibiotics to get in to the actual sac where the bacteria are camping out, so the correct treatment is drainage. This is not something you should try at home, kiddies. The skin needs to be cleaned, properly numbed up and the bursa opened with a scalpel. Packing the cavity with gauze for a few days helps encourage drainage. With proper drainage, antibiotics are not always necessary, but most doctors prescribe them anyway. Hot soaks will help this resolve even faster.

Internal Medicine docs usually shy away from anything having to do with cutting but Family Doctors, General Surgeons, Orthopedists and even Walk-in Clinics handle this sort of problem all the time. If you must, you can always visit someone like me in the vast health-care safety net called the ER, but you’ll have to wait your turn among heart attacks, vomiting babies and drunks whose dogs ate their pain pills. They key point is do not heat up a needle and try to stab this thing yourself. You’ll probably do more harm than good.

This condition isn’t limited to brick-and-mortar rail leaners. Internet poker junkies who prop up their head for hours at a time staring at their screen can get it too. Just keep in mind that if it’s a small painless collection of fluid, just stop leaning on your elbow and it will probably get better. Once it gets red, hot and painful, seek help from a physician.

One more note for the real poker professionals out there, this is clearly a work related injury and qualifies for workers comp coverage. You DO have workers comp don’t you, Phil?

http://www.encyclopedia.com/topic/bursitis.aspx