Septic Bursitis of the Elbow - Aspiration for Bacterial Culture

A 51-year-old woman presented with an acutely painful elbow since the previous evening. There skin over the elbow was warm and red, but there was only slight fluctuation. The ultrasonography shows how the initially invisible fluid forms a "pond" when the bursa is squeezed from the sides. To obtain a sample, the small amount of fluid inside the flat bursa must be gathered into one place. This can be done by squeezing the bursa from the sides with fingers and the puncture is performed in the middle of the bursa.

After careful cleansing of the skin, the needle is inserted slowly while maintaining light suction. It would be good to consider performing the puncture from the side, through healthy skin, in order to avoid bacteria being transferred from the skin into the joint. In the case in this video, the needle is first inserted too deep and no fluid is found. After pulling the needle backwards a small amount of fluid is finally obtained. The puncture site is covered with a self-adhesive sterile dressing, and it must not be allowed to get wet on the puncture day.

The number of leukocytes in the fluid was 6000×10⁶ /l, and Staphylococcus aureus grew in the culture. The treatment consisted of two intravenous doses of cefuroxime followed by oral cephalexin for 10 days.

Septic Bursitis of the Elbow - Aspiration for Bacterial Culture