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Olecranon Bursitis — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyOlecranon BursitisSCE Rheumatology

A 55-year-old plumber presents with an acutely swollen olecranon bursa. The swelling is warm and tender, and aspiration produces turbid bursal fluid. Which diagnosis is most important to exclude urgently?

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Correct answer: E — Septic olecranon bursitis

The correct answer is septic olecranon bursitis. Although repetitive pressure from leaning on the elbows predisposes to aseptic microtraumatic bursitis, marked warmth, tenderness and turbid bursal fluid require infection to be excluded urgently. Clinical findings alone cannot reliably distinguish septic from crystal-induced or traumatic bursitis; the aspirate should therefore undergo microscopy, Gram staining and culture, with crystal analysis also performed. Staphylococcus aureus causes most superficial septic bursitis. Gout may produce inflammatory olecranon bursitis or a firm tophus, but it does not remove the need to exclude concomitant infection. A rheumatoid nodule is usually firm rather than fluctuant, while a ganglion cyst and lipoma do not explain an acutely inflamed bursa containing turbid fluid.

Reference: Lormeau C et al. Management of septic bursitis. Joint Bone Spine. 2019;86(5):583-588. https://pubmed.ncbi.nlm.nih.gov/26577126/