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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.


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.


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.


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