Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Kyle I. -

Thanks for the segment, could you explain a bit more where the >10k number comes for the diagnosis of septic bursitis?

From Corependum:
Bursal fluid analysis is helpful in the diagnosis of infectious or rheumatologic causes of bursitis.
Bursal fluid Gram stain
Cell count with differential
WBC >2000 cells/mm3 suggest an infected bursa.※
WBC <1500 cells/mm3 suggest a non-infected bursa.
Crystal analysis

Some of the literature quoted in Corependium is from 1996 and has no explained outcomes of patients and no descriptors of how groups were specifically treated. The other was only those admitted with a positive culture from a tap showing average WBC of 73k


Gita P. -

From Dr. Raukar:
Thanks for this question. Fluid should be evaluated for cell count with differential, gram stain, culture, and crystals. As you mentioned, there were studies that showed that leukocytosis of more than 2000/mm was 94% sensitive and 79% specific for septic bursitis but then it was found that average bursal WBC was found to be around 63,000/mm. It's about likelihood ratios and probability - there is no slam dunk number that says, ok, if you meet this threshold you have it. But obviously, the higher the leukocytosis, the more likely it is.

Jim J. -

A recent abstract on EMA discussed the fact that nearly 50% of people who underwent aspiration formed a chronically draining tract. I was wondering if this is true in real world experiences. The discussion on EMA made me change my practice to be hesitant to aspirate these. (abstract below)

Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in emergency department patients Beyde A, Thomas AL, Colbenson KM, et al. Acad Emerg Med. Published online October 26, 2021. doi:10.1111/acem.14406

Gita P. -

From Dr. Raukar:
Thank you for your question. Official it is definitely a possible complication from aspiration of the bursa because the space between the skin and the bursa is so small. And the samples that, no fistula‘s were reported. And in my personal experience, I’ve not encountered this complication, either in the emergency department or in the sports medicine clinic. One way to avoid creating a fistula is to make a longer track which is done by using the Z-tract technique of aspiration. This is when you pull the skin and then insert the needle instead of going straight in. That way when you put the skin back over the site of aspiration of the bursa, there’s a longer track and you help seal the hole.

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

6 AMA PRA Category 1 Credits™ certified by PIM

  1. Quiz Not Required
  2. Complete Evaluation
  3. Print Certificate