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Olecranon Bursa Aspiration and Injection

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Other Names

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

Background

Anatomy of the olecranon bursa[1]

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%[2]
  • Ultrasound guided
    • Not well described
    • Joines et al reported a success rate of 90% to 100%[3]
  • There have not been any head-to-head studies comparing clinical outcomes of unguided versus ultrasound-guided injection of the olecranon bursa

Indications


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

Procedure

Patient positioning for procedure[4]
Alternative prone patient positioning[4]
Needle and probe position for in plane approach[4]
Ultrasound of needle in plane in the bursa[4]

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

Aftercare

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

Complications

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

See Also


References

  1. Image courtesy of https://www.rehabmypatient.com/, "Elbow (olecranon) bursitis"
  2. Lockman L. Treating nonseptic olecranon bursitis: a 3-step technique. Can Fam Physician. 2010 November;56(11):1157.
  3. Joines MM, Motamedi K, Seeger LL, DiFiori JP. Musculoskeletal interventional ultrasound. Semin Musculoskelet Radiol. 2007;11:192–198.
  4. 4.0 4.1 4.2 4.3 Malanga, Gerard, and Kenneth Mautner. Atlas of ultrasound-guided musculoskeletal injections. McGraw-Hill, 2014.
Created by:
John Kiel on 30 October 2023 14:21:02
Authors:
Last edited:
30 October 2023 15:07:11
Category: