Season 8 Case 40
History: elbow swelling
Answer: Olecranon Bursitis secondary to Gout
Obviously we have focal mass-like soft tissue swelling posterior to the olecranon with minimal soft tissue edema otherwise about the elbow. This is classic picture of olecranon bursitis
Etiologies for olecranon bursitis:
-trauma
-excessive use (aka “student’s elbow” or “baker’s” or Popeye elbow)
-infection
-inflammation (classically gout, although RA and CPPD as well)
In this case we also see soft tissue Ca++ which we wouldn’t expect to see in trauma or overuse but can be seen with gout.
The issue that often comes up by inexperienced clinicians is concern for infection and desire to aspirate (heck just google “OB” and one of the first pics has a needle). I highly suggest you DO NO ASPIRATE. Gouty OB can be swollen, tender even mildly red/warm due to the inflammation. But if it isn’t infected when you tap it, it will be afterwards. And an infected bursa can be extremely difficult to treat with Abx and might even require surgical removal.
This is not an uncommon findings and almost always due to overuse or gout/RA.So keep the needle away!
