Olecranon Bursitis Flashcards
What is olecranon bursitis?
A common inflammatory pathology of the elbow.
The bursa is particularly prone to inflammation as it is located superficially and vulnerable to pressure and trauma.
Causes of olecranon bursitis.
Repetitive flexion-extension movements at the elbow or leaning too much (called student’s elbow)
Can also be due to gout and RA (non-infective)
The bursa can also become infected due to skin abrasion or puncture due to S. aureus.
Clinical features
Pain and swelling of over olecranon.
Range of motion is usually preserved because the joint is not involved.
There should be minimal discomfort unless extremes of movement (Septic arthritis will be very painful in any movement)
If there is infection fever and lethargy might be present as well.
What other examinations should be done?
Contralateral elbow + joint above and below elbow.
Dx
Inflammatory arthropathies
Gout
Cellulitis
SA
Investigations
Routine bloods with FBC and CRP
If rheumatological cause is suspected might wanna do some specialised tests like RhF and anti-CCP.
Serum urate levels for gout or aspiration of joint.
Plain film X-ray of eblow joint (will not confirm diagnosis but can aid in ruling out any other injury)
Definitive diagnosis is aspiration of bursa fluid sent for microscopy and culture + presence of crystals.
The aspiration can also provide symptomatic relief for some patients.
Explain aspiration of olecranon bursa.
Sterile procedure where patient is sat down and elbow placed on a surface higher than their shoulder.
Swelling should be palpated and aspiration point should lie in the are of greatest fluctuance.
Needle should not enter the joint capsule and risk seeding infection.
Send for microscopy and culture
What does management depend on?
Presence of infection.
Tx if there is no infection
Analgesia (ideally NSAIDs) + rest.
Splinting of elbow might be required for a short time.
If swelling is very large and causes a lot of discomfort washout can be done in theatre.
Tx if there is infection or systemic symptoms.
Mild/Moderate
· Flucloxacillin PO
· If penicillin allergic: Doxycycline PO
Severe
· Flucloxacillin IV
· Convert to Flucloxacillin PO 1g QDS for a minimum of 2 weeks, reassess in clinic, up to 6 weeks may be required
· If penicillin allergic: Vancomycin IV
· Convert to Doxycycline PO
Review and adjust therapy on culture and sensitivity results.
IV antibiotics + surgical drainage.
Bursectomy might be needed.
Complications
Most resolve spontaneously
Can cause SA or osteomyelitis very rarely
