This is a 70 year old female who denies PMHx of osteoarthritis, rheumatoid arthritis, gout and STI’s presenting with pain and edema in the posterior left elbow for 2 weeks. Physical exam revealed a mildly tender, fluctuant mass on the posterior elbow. There were no signs of septic bursitis such as fever, erythema, warmth or purulent drainage. The patient had normal sensation to light touch, normal muscle tone, full range of motion and 5/5 strength in the elbows bilaterally. Physical exam of the left shoulder and wrist were unremarkable. These findings were consistent with non-septic olecranon bursitis. The patient initially elected for PRICE (protection, rest, ice, compression and elevation). Specifically, the patient was instructed to protect the left arm from further injury, rest her left arm, apply
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2 She should also have been instructed to keep the compressive dressing on for at least 3 days instead of just until bedtime after aspiration in order to restrict ROM of the elbow.2 Additionally. an elastic compressive sleeve or neoprene may have been another option to provide compression over the bursa and prevent accumulation of fluid. Though NSAIDS are one treatment option for bursitis, the fluid aspirated was hemorrhagic and therefore this medication was not suitable for this patient.1 Additionally, evidence supports the use of steroid injection for bursitis in athletes or those with demanding physical activity for work.2 Furthermore, though some studies have shown faster reduction in swelling, others have found greater rates of skin atrophy and infection. 3 Since the patient did not fit into the recommended patient population for steroid injections and also due to increased complication risk, steroid injection may not have been the best treatment option for
2 She should also have been instructed to keep the compressive dressing on for at least 3 days instead of just until bedtime after aspiration in order to restrict ROM of the elbow.2 Additionally. an elastic compressive sleeve or neoprene may have been another option to provide compression over the bursa and prevent accumulation of fluid. Though NSAIDS are one treatment option for bursitis, the fluid aspirated was hemorrhagic and therefore this medication was not suitable for this patient.1 Additionally, evidence supports the use of steroid injection for bursitis in athletes or those with demanding physical activity for work.2 Furthermore, though some studies have shown faster reduction in swelling, others have found greater rates of skin atrophy and infection. 3 Since the patient did not fit into the recommended patient population for steroid injections and also due to increased complication risk, steroid injection may not have been the best treatment option for