Aspiration of Olecranon Bursa Technique

Standard technique

Identify the inflamed olecranon bursa, and select a needle insertion site (if possible, over noninflamed skin). The insertion site should be posterolateral to avoid the ulnar nerve that is located medially (see the image below). Do not insert the needle on an area of overlying cellulitis; doing so may result in infection of the bursa or joint. Insert in an area with the least amount of inflammatory changes.

Ask the patient to lift his or her elbow off the side table. Apply an antiseptic solution, using circular movement from the olecranon and away; allow the solution to dry before aspiration. Place a sterile drape on the side table, and ask the patient to lower the elbow back onto the sterile drape. Apply sterile drapes around the prepared skin (see the image below).

Arm a sterile syringe filled with 1 mL of lidocaine 1% with a 25-gauge needle, and use it to raise a skin wheal over the needle insertion site (see the image below).

Arm a new 10-mL syringe with an 18-gauge needle, and break the vacuum. Insert the needle through the raised skin wheal, and advance it into the most dependent aspect of the bursa. Aspirate the bursa to drain it completely by simultaneously pulling on the syringe with one hand and milking the bursa with the other (see the image below).

Withdraw the needle (see the image below). Clean the skin, and place an adhesive bandage over the injection site.

Better sealing of the needle tract may be achievable with the Z-tract technique (see below).

Z-tract technique

To aspirate an inflamed olecranon bursa with the Z-tract technique, first follow the preparatory steps above, including positioning, sterile preparation, anesthesia, and landmark identification. Then, before inserting the needle, pull the skin overlying the needle insertion side either medially or laterally. This creates a longer subcutaneous needle tract and seals it better after the needle is removed.

After needle insertion, complete the aspiration procedure as described above.

Local infection is a rare complication that may be minimized by choosing a needle insertion site over noninflamed skin.

Fistula formation is a possible complication, given the short subcutaneous distance between skin entry and bursa. To minimize the risk of fistula formation, some authors recommend using the Z-tract technique (see Olecranon Bursa Aspiration).