Olecranon bursitis (nonseptic): Difference between revisions

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*There is controversy regarding initial diagnosis and treatment<ref> Blackwell1 JR, et al. Olecranon bursitis: a systematic overview. Shoulder & Elbow; 2014, Vol. 6(3) 182–190. DOI: 10.1177/1758573214532787</ref>
*There is controversy regarding initial diagnosis and treatment<ref> Blackwell1 JR, et al. Olecranon bursitis: a systematic overview. Shoulder & Elbow; 2014, Vol. 6(3) 182–190. DOI: 10.1177/1758573214532787</ref>


==Evaluation==
==Clinical Features==
[[File:Bursitis Elbow WC.jpg|thumb|Olecranon bursitis, nonseptic]]
*Bursal fluid on exam
*Bursal fluid on exam
*Non-erythematous
*Non-erythematous
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*Negative axial load
*Negative axial load


==Workup==
==Differential Diagnosis==
{{Elbow DDX}}
 
==Evaluation==
*Xrays if trauma, may consider for all to rule out bone spur as causative agent (although not emergent)
*Xrays if trauma, may consider for all to rule out bone spur as causative agent (although not emergent)
*Initial aspiration is controversial<ref> Blackwell1 JR, et al. Olecranon bursitis: a systematic overview. Shoulder & Elbow; 2014, Vol. 6(3) 182–190. DOI: 10.1177/1758573214532787</ref>.  There is currently no consensus on the optimal diagnosis strategy for prepatellar bursitis.  The majority of patients studied did receive an aspiration of fluid (82%), but those patients had a significantly higher rate of complications (persistent infection, secondary infection in initially aseptic bursae) than patients treated with antibiotics alone.<ref>Baumbach SF et al. Prepatellar and Olecranon bursitis: literature review and development ofa treatment algorithm.  Arch Orthop Trauma Surg.  (2014) 134: 359 - 370.</ref>
*Initial aspiration is controversial<ref> Blackwell1 JR, et al. Olecranon bursitis: a systematic overview. Shoulder & Elbow; 2014, Vol. 6(3) 182–190. DOI: 10.1177/1758573214532787</ref>.  There is currently no consensus on the optimal diagnosis strategy for prepatellar bursitis.  The majority of patients studied did receive an aspiration of fluid (82%), but those patients had a significantly higher rate of complications (persistent infection, secondary infection in initially aseptic bursae) than patients treated with antibiotics alone.<ref>Baumbach SF et al. Prepatellar and Olecranon bursitis: literature review and development ofa treatment algorithm.  Arch Orthop Trauma Surg.  (2014) 134: 359 - 370.</ref>
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***May consider initial conservative (no aspiration) treatment for several days<ref> Blackwell1 JR, et al. Olecranon bursitis: a systematic overview. Shoulder & Elbow; 2014, Vol. 6(3) 182–190. DOI: 10.1177/1758573214532787</ref>
***May consider initial conservative (no aspiration) treatment for several days<ref> Blackwell1 JR, et al. Olecranon bursitis: a systematic overview. Shoulder & Elbow; 2014, Vol. 6(3) 182–190. DOI: 10.1177/1758573214532787</ref>
***Some sources suggest aspiration for all cases
***Some sources suggest aspiration for all cases
==Differential Diagnosis==
{{Elbow DDX}}


==Management==
==Management==
*Acute
*Acute
**Avoid trauma and excessive pressure
**Avoid trauma and excessive pressure
**RICE & NSAIDs
**RICE & [[NSAIDs]]
*Chronic = surgery
*Chronic = surgery
==Disposition==
*Outpatient management


==See Also==
==See Also==
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[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Sports Medicine]]

Revision as of 16:56, 18 October 2019

Background

  • Inflamation of the bursal cavity superficial to the olecranon
  • Majority of cases are not infectious, but inflammation can be from infection (septic bursitis)
  • Also known as "student's elbow" or "baker's elbow"
  • Often caused by repeated minor trauma from external pressure to elbow
  • There is controversy regarding initial diagnosis and treatment[1]

Clinical Features

Olecranon bursitis, nonseptic
  • Bursal fluid on exam
  • Non-erythematous
  • FROM
  • Negative axial load

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

Radiograph-Negative

Pediatric

Evaluation

  • Xrays if trauma, may consider for all to rule out bone spur as causative agent (although not emergent)
  • Initial aspiration is controversial[2]. There is currently no consensus on the optimal diagnosis strategy for prepatellar bursitis. The majority of patients studied did receive an aspiration of fluid (82%), but those patients had a significantly higher rate of complications (persistent infection, secondary infection in initially aseptic bursae) than patients treated with antibiotics alone.[3]
    • If any signs of infection, must aspirate to rule out septic bursitis
    • If no signs of infection:
      • May consider initial conservative (no aspiration) treatment for several days[4]
      • Some sources suggest aspiration for all cases

Management

  • Acute
    • Avoid trauma and excessive pressure
    • RICE & NSAIDs
  • Chronic = surgery

Disposition

  • Outpatient management

See Also

References

  1. Blackwell1 JR, et al. Olecranon bursitis: a systematic overview. Shoulder & Elbow; 2014, Vol. 6(3) 182–190. DOI: 10.1177/1758573214532787
  2. Blackwell1 JR, et al. Olecranon bursitis: a systematic overview. Shoulder & Elbow; 2014, Vol. 6(3) 182–190. DOI: 10.1177/1758573214532787
  3. Baumbach SF et al. Prepatellar and Olecranon bursitis: literature review and development ofa treatment algorithm. Arch Orthop Trauma Surg. (2014) 134: 359 - 370.
  4. Blackwell1 JR, et al. Olecranon bursitis: a systematic overview. Shoulder & Elbow; 2014, Vol. 6(3) 182–190. DOI: 10.1177/1758573214532787