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Purpose:
Although aspiration of septic olecranon bursitis is recommended in the literature, no high-level evidence exists to support this practice. The purpose of this study was to retrospectively compare the results of traditional bursal aspiration (TBA) with empirical management without aspiration (EM). We hypothesized that EM of uncomplicated s...
Contexts in source publication
Context 1
... average subject age was 44.2 years (range, 25e81 years), and 26 of 30 (87%) were men. Subjects treated with TBA or EM were similar with respect to age, sex distribution, white blood cell count, C-reactive protein, and erythrocyte sedimentation rate (Table 1). All but 2 patients were compliant with a compressive dressing wear and a short period of orthosis immobilization (w 7 days). ...Context 2
... average subject age was 44.2 years (range, 25e81 years), and 26 of 30 (87%) were men. Subjects treated with TBA or EM were similar with respect to age, sex distribution, white blood cell count, C-reactive protein, and erythrocyte sedimentation rate (Table 1). All but 2 patients were compliant with a compressive dressing wear and a short period of orthosis immobilization (w 7 days). ...Similar publications
Liana J Tedesco,1 Hasani W Swindell,1 Forrest L Anderson,1 Eugene Jang,1 Tony T Wong,2 Jonathan K Kazam,2 R Kumar Kadiyala,3 Charles A Popkin1 1Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA; 2Department of Radiology, New York Presbyterian Hospital, New York, NY, USA; 3Department of Orthopedic...
Citations
... Bacterial identification rarely led to a change in antibiotic molecule (< 1 in 10 cases) [33]. Furthermore not having bacterial identification was not associated with a higher rate of failure [14]. ...
... Thus, bursal puncture does not seem to be mandatory but the practitioner may want help with diagnostic orientation and/or management, at bursitis onset or during follow-up (sterilization of bursal fluid with antibiotic treatment is obtained after 4 days of treatment [16]). In published studies, bursal puncture was performed in 36-80% of patients [14,15,33,34]. ...
... After 4 days of IV treatment (range: 1-14 days), clindamycin was prescribed in 55% and cephalexin in 25% of patients for a median duration of 7 days (range: 5-30 days). The median total duration of antibiotics was 12 days (range: 8-35 days); • the second study included 30 patients with olecranon SB [33]. Nineteen patients were treated empirically. ...
... Bacterial identification rarely led to a change in antibiotic molecule (< 1 in 10 cases) [33]. Furthermore not having bacterial identification was not associated with a higher rate of failure [14]. ...
... Thus, bursal puncture does not seem to be mandatory but the practitioner may want help with diagnostic orientation and/or management, at bursitis onset or during follow-up (sterilization of bursal fluid with antibiotic treatment is obtained after 4 days of treatment [16]). In published studies, bursal puncture was performed in 36-80% of patients [14,15,33,34]. ...
... After 4 days of IV treatment (range: 1-14 days), clindamycin was prescribed in 55% and cephalexin in 25% of patients for a median duration of 7 days (range: 5-30 days). The median total duration of antibiotics was 12 days (range: 8-35 days); • the second study included 30 patients with olecranon SB [33]. Nineteen patients were treated empirically. ...
... Empiric antibiotic management alone has been advocated by some authors with promising clinical results. In a retrospective review, Deal et al. [24] compared aspiration verified uncomplicated olecranon bursitis plus antibiotic treatment to empiric antibiotic management alone. Diagnosis was made based on the presence of warmth and erythema over the olecranon bursa with elevated ESR and CRP. ...
... None of them required bursectomy. The authors opined that empiric antimicrobial management was ideal, minimizing the risk of draining sinus tracts that can require surgical management for uncomplicated olecranon bursitis [24]. In a retrospective study by Beyde et al. [25 •], the authors reviewed patient Emergency Department (ED) visits over an 8-year period, presenting with presumed olecranon bursitis. ...
Septic bursitis is a relatively common condition that causes substantial morbidity, but there is no universally accepted approach to management. We aim to evaluate recent literature with an eye toward recommended changes in the practice of bursal aspiration, surgical debridement, and antibiotic treatment.
Authors of recent studies suggest that most patients with uncomplicated septic bursitis can be treated nonoperatively, perhaps even without aspiration of the bursal sac, and can achieve satisfactory clinical response with antibiotics alone. Surgical debridement has not been shown to be superior to nonoperative approaches but is recommended for complex or refractory cases. Optimal antibiotic route and duration is largely determined by severity of the presentation, but many authors favor transition to oral antibiotic therapy early where appropriate.
There remains considerable heterogeneity regarding the best management of septic bursitis, ranging from aggressive surgical debridement to isolated antibiotic treatment. Bursal aspiration can help to guide antimicrobial therapy but is not necessarily a requirement in making the diagnosis if patients show an adequate response to empiric antibiotics. Close follow-up after initial presentation for patients with proven or suspected septic bursitis is important to determine their clinical response and to further guide their management.
... A common presentation of bursitis occurs at the olecranon due to its location and minimal vascularity making it more subject to trauma [3]. Two-thirds of olecranon bursitis cases are aseptic, the remaining of which are considered septic or infected [4,5]. The incidence of olecranon bursitis in a study conducted in the military population is estimated to be 0.01% and increases to 0.1% in inpatient populations [6,7]. ...
... The clinical presentation of olecranon bursitis is characterized by an enlarged bursa, erythema, and pain on flexion [11,4,5]. Clinical examination alone may be inadequate to distinguish between superficial and septic bursitis. ...
... The recommendation for diagnosis of septic bursitis is through the analysis of the aspirated bursal fluid using ultrasonography. However, the procedure of aspiration can pose a high risk of sinus tract formation [5]. In our patient, given the lack of systemic symptoms, and this visit being several days post-injury, the likelihood of septic bursitis was very low. ...
The authors present a case of traumatic olecranon bursitis, initially presumed to be cellulitis. The clinical presentation, diagnosis, and management are discussed.
... Superficial infectious bursitis is usually treated with antibiotics, often empirically to avoid iatrogenic infection from aspiration [67]. Percutaneous drainage and surgical bursectomy are reserved for extremely distended bursae and refractory cases that do not respond to antibiotic therapy [1,65,68]. ...
Magnetic resonance imaging (MRI) is a powerful imaging modality in the evaluation of musculoskeletal (MSK) soft tissue, joint, and bone infections. It allows prompt diagnosis and assessment of the extent of disease, which permits timely treatment to optimize long-term clinical outcomes. MRI is highly sensitive and specific in detecting the common findings of MSK infections, such as superficial and deep soft tissue oedema, joint, bursal and tendon sheath effusions, lymphadenopathy, bone marrow oedema, erosive bone changes and periostitis, and bone and cartilage destruction and sequestration. Contrast-enhanced MRI allows detection of non-enhancing fluid collections and necrotic tissues, rim-enhancing abscesses, heterogeneously or diffusely enhancing phlegmons, and enhancing active synovitis. Diffusion-weighted imaging (DWI) is useful in detecting soft-tissue abscesses, particularly in patients who cannot receive gadolinium-based intravenous contrast. MRI is less sensitive than computed tomography (CT) in detecting soft-tissue gas. This article describes the pathophysiology of pyogenic MSK infections, including the route of contamination and common causative organisms, typical MR imaging findings of various soft tissue infections including cellulitis, superficial and deep fasciitis and necrotizing fasciitis, pyomyositis, infectious bursitis, infectious tenosynovitis, and infectious lymphadenitis, and of joint and bone infections including septic arthritis and osteomyelitis (acute, subacute, and chronic). The authors also discuss MRI findings and pitfalls related to infected hardware and diabetic foot infections, and briefly review standards of treatment of various pyogenic MSK infections.
... Patients with symptomatic olecranon bursitis commonly present to the emergency department (ED) for evaluation. 1 Up to 50% of all olecranon bursitis cases in the ED are septic in nature. 2 It is important to recognize and appropriately treat these cases to prevent complications including septic arthritis and sepsis. 3 The ED evaluation and diagnosis of septic bursitis is widely variable and often based on anecdotal evidence. 4 Diagnostic aspiration of the olecranon bursa to assess for septic bursitis is commonly recommended and performed [1][2][3]5,6 despite the paucity of evidence to support this practice. ...
... 3 The ED evaluation and diagnosis of septic bursitis is widely variable and often based on anecdotal evidence. 4 Diagnostic aspiration of the olecranon bursa to assess for septic bursitis is commonly recommended and performed [1][2][3]5,6 despite the paucity of evidence to support this practice. 3 Aspiration may increase the risk for complications including chronic fistula formation, infection, and need for a future bursectomy. ...
... 4 Diagnostic aspiration of the olecranon bursa to assess for septic bursitis is commonly recommended and performed [1][2][3]5,6 despite the paucity of evidence to support this practice. 3 Aspiration may increase the risk for complications including chronic fistula formation, infection, and need for a future bursectomy. 2,3,7 There are only limited studies focused on ED evaluation and management of septic bursitis. ...
Objectives
Many guidelines for septic olecranon bursitis recommend aspiration of the bursa prior to initiation of antimicrobial therapy despite the absence of robust clinical data to support this practice and known risk of aspiration complications. Our objective was to describe outcomes associated with empiric antibiotic therapy without bursal aspiration among emergency department (ED) patients with suspected septic olecranon bursitis.
Methods
We conducted a retrospective observational cohort study of patients presenting to an academic ED from January 1, 2011 to December 31, 2018 with olecranon bursitis. The health record was reviewed to assess patient characteristics and outcomes within 6 months of the ED visit. Olecranon bursitis was considered “suspected septic” if the patient was treated with antibiotics. The primary outcome of interest was complicated versus uncomplicated bursitis resolution. Uncomplicated resolution was defined as bursitis resolution without subsequent bursal aspiration, surgery, or hospitalization.
Results
During the study period, 264 ED patients were evaluated for 266 cases of olecranon bursitis. The median age was 57 years and 85% were men. Four (1.5%) patients had bursal aspiration during their ED visit, 39 (14.7%) were admitted to the hospital, 76 (28.6%) were dismissed without antibiotic therapy, and 147 (55.3%) were dismissed with empiric antibiotic therapy for suspected septic olecranon bursitis. Among these 147 patients, 134 had follow-up available including 118 (88.1%, 95% CI 81.1-92.8%) with an uncomplicated resolution, 8 (6.0%, 95% CI 2.8-11.8%) who underwent subsequent bursal aspiration and 9 (6.7%, 95% CI 3.3-12.7%) who were subsequently admitted for inpatient antibiotics.
Conclusions
Eighty-eight percent of ED patients with suspected septic olecranon bursitis treated with empiric antibiotics without aspiration had resolution without need for subsequent bursal aspiration, hospitalization, or surgery. Our findings suggest that empiric antibiotics without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis.
... In less severe cases of SB in particular, patients are most often managed by their GP without bursal aspiration and an empirical strategy led to a resolution of the infection in most cases in two previous studies. 9,13 However, bursal fluid aspiration is still recommended when SB occurs or recurs following a bursal steroid injection. In these conditions, some fungal or mycobacterial infections have effectively been reported. ...
Background:
No current guidelines are available for managing septic bursitis (SB).
Objectives:
To describe the clinical characteristics and management of olecranon and prepatellar SB in five French tertiary care centres.
Methods:
This is a retrospective observational multicentre study. SB was diagnosed on the basis of positive cultures of bursal aspirate. In the absence of positive bursal fluid, the diagnosis came from typical clinical presentation, exclusion of other causes of bursitis and favourable response to antibiotic therapy.
Results:
We included 272 patients (median age of 53 years, 85.3% male and 22.8% with at least one comorbidity). A microorganism was identified in 184 patients (67.6%), from bursal fluids in all but 4. We identified staphylococci in 135 samples (73.4%), streptococci in 35 (19%) and 10 (5.5%) were polymicrobial, while 43/223 bursal samples remained sterile (19.3%). Forty-nine patients (18%) were managed without bursal fluid analysis. Antibiotic treatment was initially administered IV in 41% and this route was preferred in case of fever (P = 0.003) or extensive cellulitis (P = 0.002). Seventy-one (26%) patients were treated surgically. A low failure rate was observed (n = 16/272, 5.9%) and failures were more frequent when the antibiotic therapy lasted <14 days (P = 0.02) in both surgically and medically treated patients.
Conclusions:
Despite variable treatments, SB resolved in the majority of cases even when the treatment was exclusively medical. The success rate was equivalent in the non-surgical and the surgical management groups. However, a treatment duration of <14 days may require special attention in both groups.
... Indeed, increasing years of work experience had a negative association with adherence likelihood. This observation is contrary to previous studies where years of work experience associated with better professional practices by nurses and other clinical personnel [12,26,32]. Perhaps, the differences in methodology, cadre of respondents and clinical settings explain these variances in findings. ...
Background
It is estimated that millions of patients are affected by healthcare associated infections (HAIs) each year. In Ghana, high prevalence of HAIs in relation to non-surgical (also called contaminated wounds) and surgical wounds (also called sterile wounds) is largely attributed to poor adherence to policy protocols for wound management by frontline clinical staff especially nurses.
Objective
Investigate the extent to which nursing staff adhere to the policy protocol for management of non-surgical and surgical wounds in selected public health facilities in Ghana.
Methodology
This is an analytic case study among nursing staff (n = 140) in three government facilities in the Volta region of Ghana. Subjective and objective performance scores of staff on adherence proxies were compared using the Wilcoxon Signed-rank test, and univariate ordered logistic regression analysis used to predict staff likelihood of adherence to policy protocols on non-surgical and surgical wound management.
Findings
Overall, staff self-rated themselves higher on subjective performance proxies relative to their objective scores (p<0.05). Staff with more years of work experience did not translate into a higher likelihood of adhering to standard protocol on wound management (Coef. = -0.49, CI = -0.93–0.05, p = 0.036). Being a senior nursing officer relative to lower nursing ranks increased staff likelihood of complying particularly with standard policy protocol for management of non-surgical wounds (Coef. 5.27, CI = 0.59 9.95, p = 0.027).
Conclusion
There is the need for accelerated in-service training for staff on standard protocols for wound management coupled with supportive supervisions. Staff adherence to standard quality care protocols should be a pre-requisite for licensing of health facilities by regulatory bodies like Health Facilities Regulatory Agency and National Health Insurance Authority.
... Another recent review also demonstrated that empiric antibiotic treatment without aspiration can be used to successfully treat septic olecranon bursitis. 13 Despite this, multiple arthroscopic and open surgical interventions have been described. [14][15][16] Tuff and Chrobak published a case report of septic olecranon bursitis in hockey players diagnosed with bursal aspiration. ...
Liana J Tedesco,1 Hasani W Swindell,1 Forrest L Anderson,1 Eugene Jang,1 Tony T Wong,2 Jonathan K Kazam,2 R Kumar Kadiyala,3 Charles A Popkin1 1Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA; 2Department of Radiology, New York Presbyterian Hospital, New York, NY, USA; 3Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USACorrespondence: Charles A PopkinColumbia University Medical Center, 622 West 168 St, PH – 11, New York, NY 10032, USAEmail cp2654@columbia.eduAbstract: Ice hockey continues to be a popular, fast-paced, contact sport enjoyed internationally. Due to the physicality of the game, players are at a higher risk of injury. In the 2010 Winter Olympics, men’s ice hockey had the highest injury rate compared to any other sport. In this review, we present a comprehensive analysis of evaluation and management strategies of common hand, wrist, and elbow injuries in ice hockey players. Future reseach focusing on the incidence and outcomes of these hand, wrist and elbow injuries in ice hockey players is warranted.Keywords: ice hockey, dorsal ulnotriquetral ligament, olecranon bursitis, Os styloideum, gamekeeper’s thumb
