Causes and findings:
• Sustained compression or fall/direct blow onto elbow
• Rheumatoid arthritis or gout
• Infection
• Pain at posterior aspect of elbow joint
• Painful: passive flexion and sometimes extension resisted extension occasionally
• Tender area over bursa and often obvious swelling
Equipment:
Syringe - 2ml
Needle - 23G 1.25 inches (25mm) blue
Kenalog 40 - 20 mg
Lidocaine - 1.5 ml 2%
Total volume - 2 ml
Anatomy:
The bursa lies subcutaneously at the posterior aspect of the elbow and is approximately the size of a golf ball.
Technique:
• Patient sits with supported elbow at right angle
• Identify centre of tender area of bursa
• Insert needle into this point
• Inject solution as a bolus
Aftercare:
Advise relative rest for 1 week, then resumption of normal activities avoiding leaning on elbow.
Comments:
If swelling is present, always aspirate first. If suspicious fluid is withdrawn, infiltration should not be given until the aspirate has been investigated. Occasionally a direct blow or fall can cause haemorrhagic bursitis. In these cases, the treatment should be immediate aspiration of all blood prior to infiltration.
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