Aspiration of olecranon bursitis

Aspiration of olecranon bursae can be for either diagnosis or for therapaeutic purposes (1).

Aspiration may be carried out

• acutely for relief of swelling and discomfort (2)
• to differentiate septic from non septic bursitis in cases where medical history and physical examination is insufficient (3)

The appearance of the fluid may be used to identify the nature of bursitis:

• if the aspirate is purulent - septic bursitis is the likely cause
• in non septic bursitis - colour of the aspirate may range from straw colored to bloody (3)

The bursal fluid aspirate should be sent (in a sterile container) to the laboratory for Gram staining, culture and microscopy (2,4)

• presence of urate crystals indicate gout
• 30% of gram stain is negative in patients with septic bursitis (1)
• causative organisms can be identified (if not already received antibiotics) through bacterial culture "
• white cell count is greater than 100 x 109/litre (range 1-300) in septic cases (4)

Aspiration technique (5)

Sterile technique must be followed when aspirating for bursal fluid

• patient should be in supine position and the elbow should be flexed as much as the patient can comfortably tolerate
• a 10 mL or 20 mL syringe, 18 or 20 gauge 1-inch needle is used
• insert the needle directly into the bursa
• apply a pressure dressing after the procedure

The patient should be advised to:

• avoid strenuous activity for 48 hours
• treat any pain which might occur with ice and non steroidal anti inflammatory drugs (1)

Reference:

• 1. Wiler JL. Symptoms: Swollen, Painful Elbow. Emergency Medicine News 2008;30(8):4-12
• 2. Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. 2002;66(11):2097-100
• 3. McAfee JH, Smith DL. Olecranon and prepatellar bursitis. Diagnosis and treatment. West J Med. 1988;149(5):607-10
• 4. Stell IM. Septic and non-septic olecranon bursitis in the accident and emergency department--an approach to management. J Accid Emerg Med. 1996;13(5):351-3
• 5. Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. 2002;66(11):2097-100