Septic Bursitis Aspiration

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Jess Mason demonstrates a technique for aspirating the olecranon bursa. There is redness, warmth, and tenderness over the olecranon bursa, and it does not follow the anatomic pattern of the joint. The patient is able to fully range the joint and is focally tender to the bursa. The aspirate is seropurulent with chunks of crystals. Results showed uric acid crystals and staph aurerus, so this patient has both gout (in the bursa) and septic bursitis. He was treated with antibiotics and referred for to orthopedics for possible I&D of the bursa. Some cases of septic bursitis are managed by serial needle aspirations, and if the swelling resolves, sometimes with just antibiotics and NSAIDs. Be aware that these patients can become septic.

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Greg M. -

I was curious to why a central incision wasn't made over the point of the olecranon and the bulk of the contents expressed. Was this because the patient was getting referred to surgery for debridement?

Jess Mason -

Yes, referring for debridement is my preference.

David C., MD -

Pnt won't get better without primary I&D so might as well just do it.

Axel E., M.D. -

This is a bad looking one, difficult to aspirate . I&D also preferred.
I rarely see cases of knee or olecranon bursitis as bad as this one here (France, Paris area), and remember 2 cases I sent to the Orthopods one with diffuse redness and swelling down to half way forarm, not "septic looking". There may be more severe (long untreated) cases in more rural areas wher people don't go to the doctor easily.

R J E., M.D. -

I agree with the other commenters: Just go ahead and I & D right over the olecranon, then penrose or wick. The concern regarding a persistent leak is a non-issue, as ongoing drainage is what is needed.

Timothy M. -

I do wound care as well as EM. That's an angry looking bursa! I think that the skin surface changes seen here suggest substantial necrosis at the bursa sac as well. I would open the bursa widely with a central incision, irrigate aggressively and then either pack or leave penrose in place.
It would be very interesting to see what ortho did and how the patient heals. Thanks for the video.

rebecca l. -

I just has 1 of these today. ortho said don't drain or I&D b/c they fear the persistant leak. we placed on ancef and admitted for serial exam. I have also had them d/c the pt home w/ close f/u on abx w/o aspiration.

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