Aspiration of Olecranon Bursitis

If you are going to aspirate a bursitis the needle must be introduced through an area of skin that does not appear infected. Avoid introducing a skin infection into a potentially sterile space. Prep the skin with cleansing solution. We used a 21-gauge 1.5 inch needle on a 30 ml syringe. We approached from the medial side to avoid erythematous skin. You can offer the patient a lidocaine injection first, versus attempting without local anesthetic, since they will feel one poke either way. A topical anesthetic or an ice pack are other options to reduce pain. If no fluid is initially obtained, redirect the needle by withdrawing it to the skin and advancing at a new angle. The synovial fluid can be tested for cell count and culture if concerned for septic bursitis. It can also be tested for crystals if gout is a concern. Once the needle is removed, place a bandage and a compression dressing. Advise the patient to wear the compression dressing to avoid reaccumulation, and avoid the repetitive motion that is causing the inflammation.

There is controversy on the utility of this procedure, antibiotics, and the potential for development of a fistulous tract. These have been discussed on previous episodes of EM:RAP and EMA.

Thank you to our expert peer reviewer, Neha Raukar, MD.