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J Accid Emerg Med 1996 Sep;13(5):351-353

Septic and non-septic olecranon bursitis in the accident and emergency department--an approach to management.

Stell IM

Accident and Emergency Department, Guy's Hospital, London, United Kingdom.

Olecranon bursitis is relatively common. One third of episodes are septic. Most of the remainder are non-septic, with occasional rheumatological causes. Trauma can cause both septic and non-septic olecranon bursitis. Clinical features are helpful in separating septic from non-septic olecranon bursitis, but there may be local erythema in both. Aspiration should be carried out in all cases, and if the presence of infection is still in doubt, microscopy, Gram staining, and culture of the aspirate will resolve the issue. Septic olecranon bursitis should be treated by aspiration, which may need to be repeated, and a long course of antibiotics. Some cases will need admission, and a few will need surgical treatment. Non-septic olecranon bursitis can be managed with aspiration alone. Non-steroidal anti-inflammatory drugs probably hasten symptomatic improvement. Intrabursal corticosteroids pro duce a rapid resolution but concern remains over their long term local effects. Recovery from septic olecranon bursitis can take months.

J Am Board Fam Pract 1995 May;8(3):217-220

Septic olecranon bursitis: recognition and treatment.

Shell D, Perkins R, Cosgarea A

Department of Family Medicine, Ohio State University, Columbus, USA.

BACKGROUND: The superficial location of the olecranon bursa places it at high risk for injury, possibly leading to the entry of bacteria into the bursal sac. Early differentiation between septic and nonseptic olecranon bursitis is paramount to direct therapy, to hasten recovery, and to prevent chronic inflammation. METHODS: A literature review was performed using MEDLINE files from 1967 to the present. Additional references from the bibliographies of these were also utilized. RESULTS AND CONCLUSIONS: Olecranon bursitis is a common condition that requires the treating physician to be aware of the predisposing factors, clinical signs and symptoms, and laboratory findings of both septic and nonseptic olecranon bursitis. With early recognition, prompt therapy, and preventive measures, the morbidity of septic olecranon bursitis can be considerably reduced, but surgical incision and drainage or excision could be required if conservative therapy fails.

J Rheumatol 1991 Jan;18(1):112-114

Hemorrhagic subcutaneous bursitis.

Strickland RW, Vukelja SJ, Wohlgethan JR, Canoso JJ

Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307-5001.

Hemarthrosis is a well recognized complication of a number of conditions. Hemorrhagic subcutaneous bursitis is less understood. We encountered a patient with a myeloproliferative disease who developed hemorrhagic olecranon bursitis. Upon reviewing other patients with subcutaneous bursitis, we found that hemorrhagic bursitis also occurs in the setting of traumatic or idiopathic bursitis, rheumatoid arthritis, gout, and septic bursitis.

Acta Orthop Scand 1987 Aug;58(4):408-409

Development of the olecranon bursa. An anatomic cadaver study.

Chen J, Alk D, Eventov I, Wientroub S

Department of Orthopedics, Tel-Aviv Medical Center, Israel.

Anatomic dissection of the elbows of 63 cadavers selected at random were performed in an attempt to find out whether the incidental disparity of olecranon bursitis between children and adults might be explained by anatomic differences. The volume of the bursae was determined by syringes used for methylene blue injections. There were no olecranon bursae in children under the age of 7 years; the volume of the bursae increased with age; and the bursa was usually larger on the right, i.e., the common dominant side. The formation of the bursae in late childhood can explain the low incidence of olecranon bursitis in children.

Acta Radiol [Diagn] (Stockh) 1982;23(3A):255-258

Traumatic olecranon bursitis. Radiologic observations.

Saini M, Canoso JJ

The affected elbow of 28 patients with traumatic olecranon bursitis was radiographically compared with the homologous elbow of 28 matched controls. Olecranon spurs, amorphous calcium deposits, or both, were present in 16 patients and 4 controls (p less than 0.01). Air was injected in the bursa in 12 additional patients. Nodules in the bursal floor were noted in 10, and the bursa was partially septated in 8. Olecranon spurs, present in 6 patients, corresponded to the insertion of the triceps tendon. With elbow flexion the bursa flattened and lengthened while the olecranon process glided distally beneath the bursal floor.

Ann Intern Med 1978 Jul;89(1):21-27

Septic bursitis in the prepatellar and olecranon bursae: an analysis of 25 cases.

Ho G Jr, Tice AD, Kaplan SR

Five cases of septic prepatellar and 20 cases of septic olecranon bursitis are reported. All were men, with a mean age of 47 years. Seventeen had a history of recent trauma to the affected limb or sustained pressure on knees or elbows, or both, required by certain occupations. Septic bursitis was not associated with septic arthritis and could be easily distinguished from it by the characteristic bursal swelling and joint examination. Septic bursitis was misdiagnosed as nonseptic bursitis in eight cases despite characterstic bursal fluid leukocytosis (greater than 1000 cells/mm3) and recovery of bacteria on culture. Staphylococcus aureus was identified in 22 cases; 76% were resistant to penicillin. Intravenous antibiotics and bursal fluid drainage were uniformly succesful. Oral antibiotic ttherapy was also successful unless the infection was extensive or there was underlying bursal disease. Early recognition, prompt therapy& #044; and preventive measures are necessary to reduce the morbidity of septic bursitis.

Arthritis Rheum 1977 Jul;20(6):1213-1216

Idiopathic or traumatic olecranon bursitis. Clinical features and bursal fluid analysis.

Canoso JJ

Thirty cases of idiopathic olecranon bursitis were studied. Most had previous local trauma. The process was unilateral and often associated with nontender pitting edema in cases of short duration. Ten patients exhibited a bony spur at the olecranon process, and amorphous calcific deposits were seen in 6. The bursal fluid was hemorrhagic with a xanthochromic supernatant, and the mucin clot test was poor or fair. Leukocyte count averaged 878/mm3, predominantly mononuclears. Many cells contained inclusion bodies. Glucose, total protein, and complement (C3) concentration averaged 80, 60, and 60% of the respective serum values.

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