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Don’t Miss This! Olecranon Bursitis: When to Tap

Any time a patient presents to the emergency department with a swollen joint the good emergency physician has to think “worst first.” Septic arthritis is probably the most serious thing on the differential that needs to be excluded, and must be entertained whenever a patient presents with any type of joint swelling. A missed diagnosis can result in destruction of the joint, fulminant sepsis and even death. The prevalence of septic arthritis has been estimated to be as high as 28% in one prospective ED study, and other studies have found the prevalence to be 10%.

From the history and physical exam it is quite obvious that this patient has an olecranon bursitis. He has the classic…

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Often due to repetitive micro trauma.

  I Would Do Anything for Septic Olecranon Bursitis But I Won't Tap That

Eighty-eight percent of ED patients with suspected septic olecranon bursitis treated with empiric antibiotics without aspiration had resolution without need for subsequent bursal aspiration, hospitalization, or surgery. Our findings suggest that empiric antibiotics without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis.

Articles of Interest

Battle of the Bulge: Olecranon Bursitis

Olecranon bursitis, also called baker’s or Popeye elbow, can be a painless or an irritating condition involving the bursa located near the proximal end of the ulna in the elbow over the olecranon. Normal bursae sacs generally are filled with a small amount of fluid, which helps the joint remain mobile. The sac can swell under the soft tissue from overuse or when the area sustains an injury from a bump or fall.

My Stupid Elbow and the Crisis in Health Care

A lingering hockey injury forces a science writer to reconsider his criticism of American medicine

Treating nonseptic olecranon bursitis

Olecranon bursitis is a relatively common condition characterized by pain, swelling, and inflammation of the olecranon bursa (located in the elbow). Although the overall incidence is not known, it typically affects men between the ages of 30 and 60 years. Two-thirds of cases are nonseptic (ie, without infection) and usually occur when trauma or repeated small injuries lead to bleeding into the bursa or release of inflammatory mediators.

Treating nonseptic olecranon bursitis

The aspiration and injection is performed directly into the bursa using a lateral approach in order to avoid the ulnar nerve which passes medial to the olecranon process,behind the medial epicondyle in the cubital canal. The olecranon bursa is the only bursa of the elbow joint.

Resources

Physiopedia

Other common causes of olecranon bursitis, which are not related to sports activities, include repetitive microtrauma, like rubbing constantly the elbow against a table during writing.

StatPearls

Whether it be traumatic or the introduction of an infectious pathogen, the inciting event causes a reactive inflammation in the bursa. The inflammatory cascade causes the extravasation of protein and synovial type fluid into the bursa. The result is the marked round swelling associated with this condition.

WikiSM

The olecranon bursa represents a superficial bursa located between the deep surface of the Triceps Brachii anatomy and bony Olecranon.