Aspiration of Olecranon Bursa

No Results

No Results

processing….

When a bursa becomes inflamed, it may be categorized as either septic (infective) or aseptic (noninfective). Aseptic bursitis is a sterile inflammation, which may occur secondary to acute trauma, overuse injury, crystal deposition (eg, gout, pseudogout), or systemic disease (eg, rheumatoid arthritis [RA], uremia, systemic lupus erythematosus). Aseptic cases account for approximately two thirds of all bursitis diagnoses.

Septic bursitis is the inflammation of a bursa secondary to the seeding of the bursal sac with microorganisms; most commonly, these microorganisms are bacteria, but they can, rarely, be fungus or algae. Seeding most often occurs transcutaneously after trauma to the region overlying the bursa. ^{[1, 2]}

Clinically, septic bursitis is difficult to distinguish from its aseptic counterpart. Roughly 40% of patents with septic bursitis are found to have clinically significant fever (>38°C/100.4°F). Bursal warmth is almost uniformly noted in infective cases but is observed only 50% of the time in those with no infection. Peribursal cellulitis is noted in more than 60% of septic bursitis cases but only 25% of noninfective cases.

It should be recognized, however, that a clear diagnosis of cellulitis can be difficult, in that the findings of erythema, increased warmth, and tenderness may be local inflammatory changes rather than true peribursal cellulitis. Tenderness is usually present in all bursitis cases; however, the degree of tenderness seems to be far more pronounced in septic bursitis than in aseptic bursitis. ^[3]

Aspiration of of an inflamed olecranon bursa is performed to obtain fluid for analysis. Noninfective (aseptic) bursitis is distinguished from infective (septic) bursitis.

Definitive diagnosis of septic bursitis can be made only by culture isolation of the causative organism. Bursal aspirates in septic cases almost always have markedly elevated white blood cell (WBC) counts (>100,000/µL) with a predominance of neutrophils. Fluid from an inflamed aseptic bursa may show a moderately increased WBC count; however, the predominant cell type is mononuclear. In addition, a bursal fluid glucose–to–serum glucose ratio lower than 50% is virtually exclusive to septic bursae. ^{[4, 5]}

Whereas olecranon bursitis is usually sterile, the olecranon bursa is the most frequent site of septic bursitis and, therefore, should not be injected with steroids before fluid analysis. ^[6]

Contraindications for aspiration of the olecranon bursa include the following:

Stell IM. Septic and non-septic olecranon bursitis in the accident and emergency department–an approach to management. J Accid Emerg Med. 1996 Sep. 13 (5):351-3. [Medline].

Ho G Jr, Tice AD. Comparison of nonseptic and septic bursitis. Further observations on the treatment of septic bursitis. Arch Intern Med. 1979 Nov. 139 (11):1269-73. [Medline].

Wasserman AR, Melville LD, Birkhahn RH. Septic bursitis: a case report and primer for the emergency clinician. J Emerg Med. 2009 Oct. 37 (3):269-72. [Medline].

Ho G Jr, Tice AD, Kaplan SR. Septic bursitis in the prepatellar and olecranon bursae: an analysis of 25 cases. Ann Intern Med. 1978 Jul. 89 (1):21-7. [Medline].

Raddatz DA, Hoffman GS, Franck WA. Septic bursitis: presentation, treatment and prognosis. J Rheumatol. 1987 Dec. 14 (6):1160-3. [Medline].

Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. 2002 Dec 1. 66 (11):2097-100. [Medline].

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Aspiration of Olecranon Bursa

Research & References of Aspiration of Olecranon Bursa|A&C Accounting And Tax Services
Source

Share on Facebook

Tweet

Follow us