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olecranon bursitis

Etiology: 1) traumatic a) commonly occurs in association with contact sports b) may occur with minimal trauma - placement of elbow or forearm on hard surface (arm rests) 2) inflammatory bursitis a) gout, pseudogout (CPPD) b) rheumatoid arthritis c) infection, especially in patients on hemodialysis - Staphylococcus aureus, Streptococcus [5] Pathology: 1) aseptic 2) septic (40% of elderly) [3] Clinical manifestations: 1) posterior elbow warmth, redness & swelling [2] - non-infectious olecranon bursitis presents as swelling without erythema or tenderness 2) may present with acute swelling secondary to hemorrhage 3) aseptic olecranon bursitis generally non-tender 4) septic olecranon bursitis generally tender 5) normal range of motion - ability to flex & extend the elbow precludes intra-articular involvement [2] 6) pain & swelling on elbow extension suggest synovitis [2] Laboratory: - synovial fluid analysis for crystals, gram stain & cell count - synovial fluid culture as indicated Differential diagnosis: - epicondylitis Management: 1) if infection suspected (pain, erythema, warmth), complete aspiration of fluid using sterile technique (see laboratory) - ultrasound guidance may be indicated [5] - drainage (repeated if necessary) may be needed for clearance of infection [6,7] - antibiotics if bursa is infected - trimethoprim-sulfamethoxazole or doxycycline for MRSA - dicloxacillin (MSSA) [8] - supportive care (observation) for hemorrhagic olecranon bursitis [8] 2) rest, ice & protection preferable to bursa aspiration [5] - NSAIDs & rest if non-infectious - elbow pads to prevent future occurrences 3) avoid glucocorticoid injections

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olecranon bursa

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bursitis

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 673-74
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2018, 2021.
  3. Clyman B, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  4. Baumbach SF, Lobo CM, Badyine I, Mutschler W, Kanz KG. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg. 2014 Mar;134(3):359-70. Review. PMID: 24305696
  5. Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  6. Nchinda NN, Wolf JM. Clinical Management of Olecranon Bursitis: A Review. J Hand Surg Am. 2021 Jun;46(6):501-506 PMID: 33840568 Review.
  7. Reilly D, Kamineni S. Olecranon bursitis. J Shoulder Elbow Surg. 2016 Jan;25(1):158-67. PMID: 26577126 Review.
  8. NEJM Knowledge+ Rheumatology