GPAtlas🧭 When to suspect
Suspect olecranon bursitis in a patient presenting with a discrete, fluctuant swelling over the bony tip of the elbow (the olecranon process). The bursa is the small subcutaneous synovial sac that cushions the olecranon, and when irritated it produces excess fluid and swells.
The single most important task is to decide whether the bursitis is septic (infected) or aseptic (non-infected), because the two demand opposite management. Aseptic bursitis follows trauma (a direct blow or repetitive pressure – leaning on the elbow, the classic "student's elbow") or a systemic cause such as gout or rheumatoid arthritis. Septic bursitis follows bacterial entry through broken skin, most often Staphylococcus aureus. Infection accounts for a substantial proportion of cases and must always be considered.
The second task is to exclude septic arthritis: in bursitis the elbow joint itself moves freely, whereas a hot, globally restricted joint points to infection within the joint rather than the bursa.
| Feature | Aseptic (non-septic) | Septic |
|---|---|---|
| Onset | Gradual, over days to weeks | Often rapid, over hours to days |
| Local signs | Mild tenderness, little or no warmth | Marked tenderness, warmth, erythema, possible broken skin or surrounding cellulitis |
| Systemic features | Well, afebrile | Fever, malaise, may be systemically unwell |
| Typical cause | Trauma, leaning, gout, rheumatoid arthritis | Bacterial entry (usually Staphylococcus aureus) through a skin breach |
| Initial action | Conservative care; do not aspirate routinely | Aspirate (Gram stain, culture, crystals) and start empirical antibiotics |
Source: BASEM · NICE NG141
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.