Infection As A Cause of Elbow Pain

Infection is an important cause of pain in and around elbow. Infection can be inside the joint or structures around the joint. The spectrum ranges from fulminant infection to unrecognizable type.

Infection can cause follwing in elbow

• Bursitis
• Arthritis
• Osteomyelitis

Septic Bursitis

Septic bursitis may occur after a skin abrasion or puncture wound. Physical-examination findings are fever, erythema, and severe tenderness to palpation overlying the bursa.

Aspiration of the olecranon bursa may reveal a cloudy aspirate, and subsequent examination with gram stain and culture will confirm the diagnosis.Treatment is with oral antibiotics and repeated needle aspiration in mild cases. For patients with more severe symptoms, intravenous antibiotics, possibly in conjunction with surgical drainage, is indicated.

Septic Arthritis

Patients with septic-elbow arthritis have severe pain with active and passive range of motion of the elbow. They may be febrile, and may have an effusion. Diagnosis is confirmed by elbow-joint aspiration, gram stain, and culture.

Radiographs are expected to be normal, although they may reveal osteomyelitis in advanced, chronic cases. Treatment consists of intravenous (i.v.) antibiotics and surgical drainage.

Osteomyelitis

Osteomyelitis may develop secondary to direct local causes (e.g., open fracture) or by systemic infection. Patients may complain of localized or diffuse pain, may or may not be febrile, and may not have abnormal motion.

Radiographs may reveal lytic bone abnormalities in chronic cases, but often are unremarkable early. Nuclear imaging bone scans or white blood cell-labeled scans may be required to make the diagnosis. MRI also may be helpful.

Bone biopsy for gram stain, culture, and pathology often is needed to confirm the diagnosis and choose appropriate antibiotics therapy.

Treatment consists of several weeks i.v. antibiotics and usually requires surgical debridement.

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