Olecranon Bursa Aspiration and Injection

Other Names

• Olecranon Bursa Aspiration and Injection
• Olecranon bursa injection
• Olecranon bursa aspiration

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Background

Anatomy of the olecranon bursa

• This page refers to aspiration and/or injection of the olecranon bursa

Key Points

• Use a high frequency, linear transducer
• Olecranon bursa is typically not seen on ultrasound unless it is distended
• If unable to aspirate fluid, consider needle fenestration and manual pressure
• Apply compressive sleeve or ace wrap post procedure to reduce recurrence rate

Anatomy of the Olecranon Bursa

• Lies between the skin of the extensor surface and triceps brachii tendon and olecranon
• Creates frictionless motion between the structures during flexion and extension
• Not typically visible clinically or with imaging unless inflamed

Palpation Guidance vs Ultrasound Guidance

• Palpation guided
  • Success rate ranges between 80% and 100%
• Ultrasound guided
  • Not well described
  • Joines et al reported a success rate of 90% to 100%
• There have not been any head-to-head studies comparing clinical outcomes of unguided versus ultrasound-guided injection of the olecranon bursa

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Indications

• Olecranon Bursitis
  • Typically when failing to respond to more conservative measures
• Septic Bursitis
  • Do not inject corticosteroids if septic bursitis is suspected

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Contraindications

• Absolute
  • Anaphylaxis to injectates
  • Overlying cellulitis, skin lesion or systemic infection
  • Septic Bursitis
• Relative
  • Can be treated with less invasive means
  • Hyperglycemia or poorly controlled diabetes
  • Lack of symptom improvement with previous injection

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Procedure

Patient positioning for procedure

Alternative prone patient positioning

Needle and probe position for in plane approach

Ultrasound of needle in plane in the bursa

Equipment

• Sterile including chloraprep, chlorhexadine, iodine
• Gloves
• Needle: typically 21-25 gauge, 1.5 inch
• Syringe: 5-10 mL
• Gauze
• Ethyl Chloride
• Bandage
• Injectate
  • Local anesthetic
  • Corticosteroid
• Sterile probe cover

Ultrasound Findings

• Best visualized with a high-frequency linear array transducer
• Scan in long axis from medial-to-lateral
  • Then switch to short axis proximal-to-distal
• Common ultrasound findings include:
  • Cortical irregularities
  • Calcifications
  • Loose bodies
• Bursal fluid
  • Will appear hypoechoic to anechoic depending on complexity
  • Complex (with stromal inclusions and loose bodies)
  • Simple (no inclusions)

Ultrasound Guided: Long Axis, In Plane

• Patient Position
  • Patient is supine
  • Shoulder internally rotated, 30° flexion
• Alternative Patient Position
  • Patient is prone
  • Shoulder partially abducted, elbow flexed and hanging off table
• Transducer Position
  • Long axis to bursa
• Needle Approach
  • In plane
  • Distal to proximal or proximal to distal
  • Target: middle of bursa
• Pearls and Pitfalls
  • Use a larger guage needle, 18 is typically sufficient
  • The transducer can be used to milk the fluid out
  • Do not inject corticosteroids if infection is suspected

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Aftercare

• No major restrictions in most cases
• Can augment with ice, NSAIDS

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Complications

• Skin: Subcutaneus fat atrophy, skin atrophy, skin depigmentation
• Painful local reaction
• Infection
• Hyperglycmia
• Tendon, nerve or blood vessel injury

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See Also

• Procedures Main
• Elbow Pain Main

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