Specific Conditions

OLECRANON BURSITIS The olecranon bursa overlies the olecranon process on the extensor surface of the elbow. Patients with olecranon bursitis present with a tense, edematous bursa that is often tender to palpation. Pain elicited with range of motion at the elbow is minor until the motion tightens and compresses the distended overlying bursa. The bursa is frequently erythematous and warm.

Distinguishing nonseptic bursitis from the septic and crystal-induced forms is a clinical challenge. Patients with crystal-induced bursitis will often demonstrate gouty tophi overlying the elbow extensor surface. Presence of crystals in bursal fluid analysis is diagnostic.

Septic bursitis and nonseptic bursitis are difficult to distinguish. No definitive conclusion can be reached solely on the basis of physical exam findings or history, although one report has noted the utility of a comparison of surface temperature of the affected bursa with the unaffected side. 17 These authors reported a temperature difference exceeding 2.1°C to be highly predictive of a septic bursal fluid aspirate.

Most authors advocate the importance of aspirating bursal fluid,1 1 l9 and 20 which is performed both for diagnostic and therapeutic purposes. Bursal fluid, like joint aspirates, demonstrates characteristic findings (T§b!e..276z6). The utility of any one finding is limited, however, and the culture represents the definitive test for presence or absence of infection.

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