Aspiration of olecranon bursa is performed to obtain fluid for analysis.
A bursa can become inflamed due to infection or for noninfective reasons like trauma, overuse, crystal deposition diseases etc.
Non-infective or aseptic causes account for approximately two-thirds of all bursitis diagnoses.
Infective or septic bursitis most commonly occurs due to seeding of bacteriae or other infective agents.
An infective cause is distinguishable clinically by the presence of aggressive signs of inflammation [warmth, redness, pain, tenderness]
But clinical differentiation is not always possible
Aspiration of a bursa fluid and studying that could provide cues regarding the nature of the affliction.
A definitive diagnosis of septic bursitis can be made only by culture isolation of the causative organism but features like raised WBC [>100,000/µL] with a predominance of neutrophils do favor a diagnosis of the sepic bursa.
In contrast fluid from an inflamed aseptic bursa may show a moderately increased WBC count with mononuclear cells being the predominant type. A bursal fluid glucose–to–serum glucose ratio lower than 50% is almost diagnostic of the septic bursa.
Aspiration of the olecranon bursa should not be done in cellulitis at the needle insertion site, bacteremia and in presence of a joint prosthesis
Position the patient sitting upright on a stretcher. Rest the affected arm on a side table with the elbow flexed ninety degrees.
- A posterolateral site of insertion is chosen to posterolateral to avoid the ulnar nerve that is located medially
- Avoid insertion an area of overlying cellulitis lest the infection may be spread.
- Prepare the part and drape in a sterile towel
- Inject lidocaine 1% to raise a skin wheal over the needle insertion site
- Insert an 18-gauge needle attached to 10 ml syringe through the raised skin wheal, and advance it into the most dependent aspect of the bursa.
- Keep a pull on the syringe to aspirate the contents. Milk the bursa for complete evacuation.
- After the needle is withdrawn, clean the skin, and place an adhesive bandage over the injection site.
This provides better sealing of the needle track. In this, the skin overlying the insertion of the needle is pulled to one side [either medially or laterally] to create a longer subcutaneous needle tract and zig zag. The sealing of the tract is better.
- Local infection.
- Fistula formation [Z-tract technique minimizes the risk]
- 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.
- Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. 2002 Dec 1. 66 (11):2097-100.