Case: 45ish yo WM, PMH mild HTN and gout presents with 1-2 d h/o "swollen elbow." Abrupt onset; minimal pain with extreme ROM; no fever, chills; h/o traumatic golf swing with transient elbow pain about 2 weeks prior; regular golfer.

Afebrile, VSS, non-toxic; erythema, warmth, swelling of olecranon bursa on L; no sig pain with ROM; minimal tenderness; some swelling involving antecubital region and upper forearm; NV intact.

• Infectious bursitis = aka "septic" bursitis
• Usually involves prepatellar or olecranon bursae in young-middle age men
• Often related to recent or chronic, repetitive (gardeners, carpet layers, etc.) trauma
• 10% may not have pain or tenderness, but most do
• Only about half have associated fever or chills
• DDx includes traumatic bursitis, hemorrhagic bursitis (uremia/HD), gout, RA, or intra-articular process (r/o by ROM)
• r/o infection with bursal aspiration® send for:

• S. aureus probably > 90% of the time
• Also GABHS; anything else is rare
• If clinical picture fits, could treat empirically and wait for GS/culture

• Hospitalization/IV abx depends on co-morbidities and systemic sx
• Adequate drainage essential…serial aspirations prn
• Local soaks and analgesics prn

References: UpToDate v. 8.1; Reese & Betts, A Practical Approach to Infectious Diseases, 4^th edition; 1996.