A 35-year-old female construction worker visited the clinic two weeks ago with complaints of pain and swelling over the posterior aspect of the right elbow, limiting her ability to extend her elbow. After a thorough examination and aspiration of elbow fluid, a diagnosis of aseptic olecranon bursitis was made. She was advised to rest, apply ice, wear a compression bandage, and take NSAIDs regularly. She returns today with no improvement in her symptoms and denies any worsening. You decide to perform a therapeutic corticosteroid injection. Where should the therapeutic injection for the treatment of olecranon bursitis be administered?
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APerpendicular to the ulna to the point of maximal tenderness, then slowly guided to the bone, and then withdrawn 2 to 3 mm to administer the injection
BDirectly into the fluid-filled bursa from either the lateral or medial side
CAt the area most tender or swollen to palpation and with the needle inserted perpendicular to the skin
DInto the soft tissue between the olecranon and triceps tendon and at a 45-degree angle toward the middle of the medial side of the joint
✓ Correct answer: B. Directly into the fluid-filled bursa from either the lateral or medial sideDirectly into the fluid-filled bursa from either the lateral or medial side is the correct answer. Conservative management is typically indicated for the treatment of aseptic olecranon bursitis. In patients who do not experience improvement of symptoms after 2-4 weeks or who experience worsening of symptoms despite conservative management, an intrabursal corticosteroid injection is indicated. For injection using aseptic technique and after administering an anesthetic, the needle should be inserted directly into the fluid-filled bursa from either the lateral or medial side, depending on practitioner preference or ease of insertion. This is why it is termed an "intrabursal" injection. Injection of the subacromial bursa (not olecranon bursitis) should be completed at the area most tender or swollen to palpation with the needle perpendicular to the skin. Injection of the Achilles bursa (not olecranon bursitis) should be completed with the needle perpendicular to the calcaneus to the point of maximal tenderness, then slowly guided to the bone, and then withdrawn 2 to 3 mm to administer the injection.
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