Review Question - QID 217371

This patient has an olecranon bursitis. If an aspiration is performed, it should be done so alone (without the addition of corticosteroid) and followed by application of a compressive dressing.

Olecranon bursitis may result either form a single injury to the elbow or more commonly secondary to repeated minor injuries, such as repeated leaning ont he point of the elbow on a hard surface. The chance of developing bursitis is higher if one's job involves a repetitive movement (ie. repetitive computer work involving leaning on one's elbow). As a reaction to injury, the lining of the bursa becomes inflamed and secretes a much greater than normal amount of fluid into the closed cavity of the bursa. Aspiration of the fluid helps to decompress the collection and allows for the bursal walls to adhere to one another to prevent swelling. The arm is then maintained in a compressive wrap to prevent swelling again.

Sayegh et al. reviewed the management of aseptic versus septic bursitis. They reported that nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management. They concluded that corticosteroid injection is associated with significant risks without improving the outcome of aseptic bursitis.

Reilly et al. reviewed septic and aseptic olecranon bursitis. They reported that the most common physical examination findings were tenderness (88% septic, 36% aseptic), erythema/cellulitis (83% septic, 27% aseptic), warmth (84% septic, 56% aseptic), report of trauma or evidence of a skin lesion (50% septic, 25% aseptic), and fever (38% septic, 0% aseptic). They concluded that distinguishing between septic and aseptic olecranon bursitis can be difficult because the physical and laboratory data overlap.

Figure A is a clinical image of an olecranon bursitis

Incorrect Answers:
Answer 1: Recurrence of the fluid collection can occur regardless of the addition of a corticosteroid injection at the time of aspiration
Answer 2: Placement of the needle for the olecranon bursa should be posterolateral to avoid any risk of injury to the ulnar nerve
Answer 4: The addition of a corticosteroid injection at the time of aspiration has been shown to significantly increase the risk of septic bursitis, likely due to the local immunosuppressive effects of the corticosteroid
Answer 5: Rupture of the lateral ulnar collateral ligament is seen with recurrent corticosteroid injections of lateral epicondylitis and should not be at risk with needle placement of olecranon bursitis aspiration