Overview of Olecranon Bursa Aspiration
An olecranon bursa is a small, fluid-filled sac located on the tip of your elbow. Sometimes, this bursa can become inflamed, a condition called olecranon bursitis. When it does, drainage of the bursa might be necessary. Olecranon bursitis, which can be either a short-term (acute) or long-term (chronic) condition, can affect anyone, regardless of their gender.
If it’s a chronic condition, it’s often seen in people who tend to lean on their elbows a lot. However, the inflammation can also be caused by an injury or an infection. To figure out the best way to drain the bursa, your doctor will need to know your medical history and examine your elbow. What they find out from the history and examination will then help them decide the best way to treat the inflammation by draining the bursa.
Anatomy and Physiology of Olecranon Bursa Aspiration
The olecranon bursa is a soft, sac-like structure located between the tip of the elbow and the skin. It functions like a cushion and sticks to both of these surfaces. This sac is filled with a lubricant called hyaluronic acid, which is a major component of a fluid present in our joints called synovial fluid. Because hyaluronic acid creates very little friction, it allows the skin and the elbow to smoothly move over each other. This prevents the bony elbow tip from poking through the skin, making it important for comfort and quality of life.
Generally, the olecranon bursa is separate from the elbow joint and doesn’t interact with it.
However, if the olecranon bursa gets irritated, it responds by swelling and producing more hyaluronic acid and other substances based on what caused the irritation. Therefore, correctly identifying the cause of the irritation is crucial in deciding the right treatment method.
Why do People Need Olecranon Bursa Aspiration
When the olecranon bursa, a small sac located near the elbow joint, becomes inflamed and painful to the point where it’s difficult to rest your elbows on a surface, it’s necessary to drain fluid from the sac. The exact cause of the inflammation, medically known as etiology, determines the treatment that will be needed.
Even if you’ve previously experienced olecranon bursitis (swelling of the olecranon bursa), each new episode doesn’t automatically mean it’s the same cause. In other words, if you’ve had this type of bursitis due to an injury before, it doesn’t automatically rule out that a current swelling could be caused by an infection.
There are three main reasons for draining an olecranon bursa:
- Diagnosing the cause (etiology).
- Relief from discomfort and pain.
- Treatment to resolve the condition.
When a Person Should Avoid Olecranon Bursa Aspiration
The olecranon bursa, a small fluid-filled sac located at the pointy bone at the back of your elbow, is normally free from any germs. It’s crucial to avoid infecting it when any medical procedure needs to be done. For example, pulling out fluid through a needle from an area of skin infection (also known as cellulitis) can inadvertently transfer harmful bacteria, and is therefore not recommended. Doctors must find a way to insert a needle into the bursa without spreading bacteria from a nearby infection.
However, if there’s suspicion that the bursa is already infected, fluid should definitely be pulled out for testing.
Moreover, if there has been a physical injury that has damaged the periosteum (a protective layer on the bone), pulling out fluid is also not recommended due to the high risk of introducing infection. For example, if the olecranon (the bone at the tip of your elbow) has been fractured, the bursa should not be tapped or drained.
Equipment used for Olecranon Bursa Aspiration
You will need certain items for this procedure:
1. A syringe, preferably 3 to 5 cc, to take out the fluid. The size of the syringe will depend on how much fluid is estimated to be there.[4]
2. A needle that is big enough to take out the thick fluid. It’s recommended that you use an 18-gauge, 1.5 inch needle.
3. A cleaner, such as chlorhexidine or betadine, to clean your skin before the procedure.
4. An optional anesthetic to help with any potential pain. This anesthetic should ideally be applied to your skin. Ethyl chloride is a good option to consider.[8]
5. Personal protection equipment such as gloves should also be used. These gloves can be clean but they don’t necessarily have to be sterile – just make sure that they’re used properly.
Who is needed to perform Olecranon Bursa Aspiration?
It’s important to have properly trained medical staff for this procedure. Medical students can learn how to do it, but they should be watched and guided by a more experienced doctor until they can be trusted to perform it on their own.
Preparing for Olecranon Bursa Aspiration
Before beginning any medical procedure, it’s crucial that the patient understands what will take place, along with the potential risks and benefits involved. They should also be made aware of any other available options. It’s only after given this information that they can make an informed decision and grant consent for the procedure to be performed.
In some cases, your doctor might make use of a special tool called an ultrasound machine if there are any doubts about skin infection in the area where the procedure will be conducted, or how much fluid might be present within the bursa (a small fluid-filled sac). This tool helps doctors see these things more clearly.
The procedure itself begins with cleaning the skin using an antiseptic solution to remove any germs. If the doctor decides to use an anesthetic to help with pain management, they might spray a substance called ethyl chloride on the skin or inject a small portion of lidocaine or a similar agent under the skin. However, if an injected anesthetic is used, they will take care to avoid entering the bursa as it would alter the test results.
How is Olecranon Bursa Aspiration performed
When treating bursitis, or inflammation of the bursa (the cushioning pad near your joints), using the correct technique is very important. The needle used to drain the bursa should be inserted in a way that it remains parallel to the ulna, one of the bones in the forearm, keeping in mind the underlying bones and structures.
The most common way of doing this is from the back of the joint. Sometimes, the front can be used as well, as long as the needle continues along the direction of the ulna. There is a third way, from the sides of the bursa, which is not often used because the needle might strike the olecranon, a part of the elbow, potentially damaging its outer surface. If there’s an infection, this could increase the chance of bone infection, or osteomyelitis, though it’s not common.
Once the needle is properly inserted into the bursa, gentle force is used to pull back (or ‘aspirate’) the plunger. After the liquid in the bursa is drained, the needle is taken out. A clean bandage is then applied to the area. Applying additional pressure using a different bandage over the clean one could be beneficial.
It’s not common to inject medications into the bursa unless we are certain that bursitis is what is causing the joint pain. Steroids, which are often used to reduce inflammation, usually don’t help if the irritation is caused by things like uric acid, which can lead to gout.
Antibiotics, which treat infections, are also generally not injected into the bursa. If the doctor thinks the bursa might be infected, it will usually be rinsed clean.
The process of hardening the bursa, or ‘sclerosis’, is not recommended. The bursa acts as both a buffer and a lubricant, so hardening it would make it unable to do its job.
Possible Complications of Olecranon Bursa Aspiration
Complications are not common when correctly drawing out fluid from the olecranon bursa, which is a small sack of fluid near the elbow joint. The most common issue is accidentally bringing infection into a bursa that was previously free of germs. In some rare cases, if there’s been an injury, blood could end up in the bursa when it wasn’t there before; this usually fixes itself with time.
At times, there might not be any fluid in the bursa. That’s why doctors can use an ultrasound at the bedside before trying to draw out fluid. This ensures there’s actually a pocket of fluid to draw from.
What Else Should I Know About Olecranon Bursa Aspiration?
Olecranon bursa aspiration is a procedure where fluid is removed from the elbow for testing. This is almost always done to help figure out what’s causing a medical issue. In this case, doctors might use an ultrasound to check whether the issue is a cyst (a fluid-filled sac) or a solid lump.
The usual causes of problems with the olecranon bursa (the small, fluid-filled sac at the point of your elbow) are trauma, infection and deterioration due to age. Less common causes can include tumors, foreign objects, and diseases that cause inflammation, such as rheumatoid arthritis, psoriatic arthritis and spondylitis.
If the cause of the swelling or fluid in the olecranon bursa isn’t clear, proper lab tests are necessary. These could include:
- Cell count with differential
- Gram stain
- Viscosity assessment
- Various cultures to check for different types of bacteria, fungi, or tubercular infections
- Crystal analysis as seen in conditions like gout and pseudogout
- Tests for inflammatory diseases (like ANA, rheumatoid factor and anti-CCP tests)
Different issues will cause different results in these tests. For example:
- Infections: The gram stain will be positive and the white blood cell to red blood cell count in the fluid may be high
- Trauma: You may see elevated red blood cells, but a consistent ratio of red to white blood cells
- Degrading over time: This could lead to an elevated white blood cell count without an infection
- Gout or pseudogout: These conditions result in the presence of crystals which can be seen under a microscope
- Rare infections (like TB or fungal infections): may need special culture tests and more investigation
- Inflammatory diseases: may have a high white blood cell count and positive tests specific to the disease
Infections and inflammation usually decrease the thickness of the bursa fluid and increase cloudiness. So, the fluid may change from clear and viscous (thick) to thin and cloudy. This change can be observed in a syringe or by simply watching a droplet of fluid. Normal fluid is thick and does not break apart easily. Abnormal fluid is thin and drips more like water.