Case Study Of Olecranon Bursitis

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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 …show more content…
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 …show more content…
al suggest that successful treatment of bursitis is dependent on correct differentiation between septic and non-septic bursitis.2 Common signs of infection are not always accurate in distinguishing these types, although two parameters, bursal warmth and fever are highly specific for septic bursitis.2 However, bursal fluid analysis is more specific in differentiating septic from non-septic bursitis and should be performed after aspiration. The aspirate should be analyzed for white cell count, fluid to serum glucose ratio, polymorphonuclear cell ratios, gram stain and culture, and presence of crytals.2 Based on supporting evidence, the patient should have had the fluid analyzed in order to distinguish the type of bursitis. Additionally, if rheumatoid arthritis was suspected, blood tests such an erythrocyte sedimentation rate, C-reactive protein and Rheumatoid factor could have been tested. If gout was suspected, a serum uric acid level should be tested as well as the bursal aspirate for crystals.1 However, there were no signs of either rheumatoid arthritis or gout in this patient so blood tests were not

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