Overuse Syndrome or Septic Joint? - Clinical Patient Case of the Week
Try this case and test your knowledge of overuse syndromes.
A 34-year-old man presents complaining of 12 hours of intense pain in his left elbow (see below).
He is a construction worker and recently sustained a laceration/abrasion on his left forearm for which he did not seek medical treatment.
He states that he feels the pain is rapidly increasing in his elbow.
On examination, he has a decreased range of motion in his right elbow due to pain in the posterior elbow area.
He has a large, boggy mass on the posterior elbow that is warm and erythematous.
What is the next best step in the management of this patient’s condition?
The correct answer is:
aspiration of the bursa with Gram stain and culture
Differentiate an overuse syndrome from a septic joint.
This patient is displaying signs and symptoms consistent with septic olecranon bursitis.
Rapid analysis of the offending pathogen is paramount to prevent further complications such as septic arthritis. As such, aspiration of the bursa and Gram stain and culture is needed immediately.
In addition, empiric antibiotic therapy is indicated for this condition that should take methicillin-resistant staphylococcus into consideration.
Cold compresses are not indicated.
Corticosteroid injection into the bursa would not be helpful.
Magnetic resonance imaging of the elbow would only delay treatment, and simple aspiration will not treat this potentially life-threatening condition.
Achar SA, Taylor KS. The 5-Minute Sports Medicine Consult. 2019
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