See for help: http://orthoinfo.aaos.org/topic.cfm?topic=a00028
I saw one in the ED and aspirated 18ml from it.
Treat conservatively first, if no improvement, aspirate
Aspirating the olecranon bursa
Get the following equipment.
-Lidocaine with Epinephrine
-30 ml Syringe
-Sterile container to take fluid to the lab ASAP. It needs to be walked over to the lab.
-Iodine solution or Povidone sticks to clean.
-4x4s
-18 gauge needle to draw lidocaine and also to aspirate the bursa with the same needle.
-27 gauge needle to inject lidocaine
As you aspirate, keep a negative pressure on the syringe.
Synovial Fluid Analysis
Order the following on the fluid you drain.
-Cell count (WBC)
-Glucose
-Protein
-Crystals
-Gram Stain
-Culture
Aseptic vs. Septic Olecranon Bursitis
“Aseptic olecranon bursitis is often preceded by minor trauma to the elbow followed by a nontender, boggy mass over the olecranon. Septic olecranon bursitis causes not just swelling, but also erythema, warmth, and pain. Half of affected individuals will have a fever. If septic bursitis is suspected, aspiration with bursal fluid analysis should be done and antibiotic therapy should be initiated. Aspiration is not recommended for the initial treatment of aseptic bursitis, as complications such as infection may occur.
Management initially is with ice, compression dressings, and avoidance of activities that aggravate the problem. If conservative therapy is unsuccessful the problem can be managed by aspiration followed by compression dressings for 2 weeks. The bursa may be injected with a corticosteroid, but this could cause skin atrophy or infection. Surgical bursectomy can be offered for refractory cases lasting over 3 months.” ABFM Critique
“Conservative treatment is the recommended initial management for olecranon bursitis when there is no history of trauma or signs of septic bursitis. Aspiration of the bursal fluid is not recommended initially due to the risk of iatrogenic infection, but can be considered for symptomatic relief if there is significant enlargement or symptoms, or for diagnosis and culture if septic bursitis is suspected. Antibiotics are not recommended for aseptic bursitis and should be delayed in septic bursitis until after aspiration for culture. MRSA coverage may be indicated if the patient is at high risk for MRSA infection. An intrabursal corticosteroid injection is not routinely recommended for bursitis unless an underlying inflammatory condition is suspected, such as gout or rheumatoid arthritis. An intrabursal hyaluronic acid injection is not a recommended treatment for bursitis.” Another ABFM critique
Reference
Evaluation of elbow pain in adults. Am Fam Physician 2014;89(8):649-657.
Evaluation of elbow pain in adults. Am Fam Physician 2014;89(8):649-657.
Common superficial bursitis. Am Fam Physician 2017;95(4):224-231.