Olecranon bursa injection is a useful diagnostic and therapeutic procedure for olecranon bursitis. This condition is usually secondary to trauma or rheumatoid arthritis.
After informed consent is obtained, the patient is placed in the sitting position with the hand on the lap. The olecranon process of the ulna is palpated for swollen bursa. The point of maximum swelling is marked. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 21-gauge needle is inserted at the most prominent part of the olecranon bursa. Aspiration is attempted until the needle has entered the synovial space. If there is an effusion of the bursa, the aspiration is completed. After negative aspiration or if the aspirated fluid is noninflammatory (clear and viscous), the bursa is injected with a 3-mL mixture of 10 mg of triamcinolone acetonide (or equivalent) and local anesthetic (Fig. 67-40).
FIGURE 67-40. Olecranon injection. Approach for olecranon aspiration and injection.
This procedure may require an 18-gauge needle to aspirate the bursa with highly viscous fluid.
Corticosteroids should not be injected if there is any suspicion that the bursa is infected. If the fluid appears infected, it should be sent for culture and sensitivity and the patient treated appropriately for the infection.