TABLE 2786 Characteristics of Bursal Fluid in Patients with Septic and Nonseptic Olecranon and Prepatellar Bursitis

Aspiration of olecranon bursitis fluid is undertaken by means of a lateral approach to the affected bursa. As in joint aspirates, a sterile technique should be utilized, with evacuation of as large amount of fluid as possible.

Management of patients with olecranon bursitis follows the aforementioned general bursitis management principles. When a septic bursitis is definitively excluded, a steroid injected into the bursa may expedite resolution of inflammation.20 However, a septic process usually cannot be excluded during the initial evaluation of an acute olecranon bursitis. As a consequence, utilization of steroid injection should be approached with caution.

Antibiotic treatment is usually effective with a 14-day course of oral antibiotic therapy. 1 19 Selected patients who may require parenteral therapy or operative management are generally distinguished by their toxic appearance, systemic signs of infection, extensive cellulitis to surrounding tissues, failure of outpatient interventions, or immunocompromised host status.

PREPATELLAR BURSITIS Prepatellar bursitis may affect any of the four bursae surrounding the extensor aspect of the knee. As in other bursitis conditions, a history of overuse or trauma to the prepatellar area is often elicited. Clinical findings are consistent with those of olecranon bursitis.

Aspiration of prepatellar bursal fluid should be approached by either a medial or lateral approach to the affected bursa. The incidence of prepatellar septic bursitis is much less than that of olecranon bursitis (approximately 75 percent less).17 Treatment emphasizes conservative management and occasionally requires antibiotic therapy or admission following the same approach as already outlined for patients with septic olecranon bursitis.

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