- inflammation of the olecranon bursa : septic or nonseptic
- male >> female. 30-60 years of age
- Risk factors
- sports
- diabetes
- uremia
- manual jobs with elbow use
- chronic hemodialysis
- Requires prolonged pressure on the elbow
- Pathogenesis
- Nonseptic Bursitis: Acute trauma or repetitive trauma causes inflammation of the olecranon bursa.
- Septic Bursitis: Infection from microorganisms transferred via trauma to the skin overlying the bursa.
- Etiology
- Trauma – acute trauma or repetitive trauma causes inflammation of the olecranon bursa
- Underlying systemic inflammatory disorder
- Avulsed osteophyte
- Infection (20% of cases) – infection from microorganisms transferred via trauma to the skin overlying the bursa
- Associated conditions
- rheumatoid arthritis
- crystalline diseases – e.g., gout or pseudogout
- Presentation
- pain or fever may suggest an infectious etiology
- Physical exam
- swelling over affected elbow
- tenderness to palpation
- erythema, ecchymosis, or abrasions of the skin
- normal range of motion
- Imaging
- Radiography – to assess for olecranon fracture or osteophyte
- Findings: Swollen bursa, fracture, or olecranon spurs.
- Labs
- indicated only when septic bursitis is suspected – ↑ WCC, ESR
- Needle aspiration of bursa with Gram stain and culture – if septic bursitis is suspected
- Aspiration of bursa fluid (Posterolateral triangle)Technique:
- Patient supine with elbow flexed
- Mark area of maximal fluctuance for skin entry
- Aspirate with 22 gauge 1 inch needle
- Drain fluid
- Apply pressure dressing after aspiration
- Treatment
- NSAIDS
- Non- septic bursitis
- Physical therapy
- rest and ice
- joint needle aspiration and drainage
- injected corticosteroids
- septic bursitis
- dicloxacillin 1 g (child: 25 mg/kg up to 1 g) orally, 6-hourly OR
- flucloxacillin 1 g (child: 25 mg/kg up to 1 g) orally, 6-hourly. OR
- cefalexin 1 g (child: 25 mg/kg up to 1 g) orally, 6-hourly. OR
- clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally, 8-hourly. OR
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- Operative: bursectomy
- Complications
- Bursa rupture
- Osteomyelitis
Related