musculoskeletal and connective tissue disorders
How To Aspirate or Inject an Olecranon Bursa
Additional Considerations for Aspirating or Injecting an Olecranon Bursa
For bursal injection, local anesthetic and depot corticosteroid can be mixed in a single syringe. Adding the anesthetic helps confirm good needle placement when injection immediately relieves pain. Adding anesthetic also may decrease the risk of the corticosteroid causing subcutaneous fat atrophy and the risk of postinjection flare. Corticosteroid injection is rarely necessary in the olecranon bursa (based on an increased risk of infection and skin atrophy and a paucity of data showing improved long-term outcomes). Septic bursitis cannot be ruled out by the initial gross and microscopic examination of the aspirated effusion; infected fluids (even from Staphylococcus aureus, the most common organism) tend to show a minimal fluid leukocytosis (although there is generally a high percentage of neutrophils).If the history or physical examination suggests septic bursitis, withhold corticosteroid injection. Septic bursitis requires drainage or sometimes bursal excision in addition to systemic antibiotics. Surgical excision of the bursa may be necessary for recalcitrant or recurrent sterile effusions or unresolving infections. 