Preliminary Diagnosis: Olecranon Bursitis
I. What imaging technique is first-line for this diagnosis?
- MRI with contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of olecranon bursitis.
Advantages
- Able to detect other causes of pain or weakness in the joint such as triceps tendinopathy, tenosynovitis, tears or ulnar nerve damage
- Does not make use of ionizing radiation
Disadvantages
- Expensive
- Time consuming
- Requires significant patient cooperation to minimize motion artifact
- Intravenous contrast requires that the patient have good renal function with a GFR greater than 60. Administration of intravenous contrast is decided individually on case-by-case basis with a GFR greater than 30 and less than 60.
III. What are the contraindications for the first-line imaging technique?
- Contraindicated in patients with non–MR-compatible metallic hardware or foreign bodes
IV. What alternative imaging techniques are available?
- Plain film radiography
- Ultrasound
- CT with or without contrast
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of olecranon bursitis.
Plain Film Radiography
Advantages
- Inexpensive and easy to perform
- Requires less patient cooperation than MRI
- Can detect associated fracture if related to trauma or osseous erosions of osteomyelitis if infectious etiology suspected
- Calcifications or gout easily seen
Disadvantages
- Nonspecific
- Unable to determine size or nature of swelling or fluid
Ultrasound
Advantages
- Able to detect fluid collection and whether fluid is simple or complex
- Can detect triceps tendinopathy, tendonitis, bursitis, tears or ulnar damage
- Relatively inexpensive and portable imaging
- Does not use ionizing radiation
Disadvantages
- Requires a skilled technician trained in musculoskeletal imaging with a high index of suspicion for detection of pathology
- Limited evaluation in obese patients
CT with or without contrast
Advantages
- Provides significant detail of bone abnormalities
- Requires less patient cooperation and is associated with less motion artifact than MR imaging
Disadvantages
- Exposes the patient to a large amount of ionizing radiation
- Associated triceps tendon and ulnar nerve damage more difficult to detect than with MRI
- Imaging with intravenous contrast requires that the patient have good renal function with a creatinine of 0.6-1.2mg/dL for an adult
VI. What are the contraindications for the alternative imaging techniques?
Plain Film Radiography
- No significant contraindications exist. Some institutions may require consent for pregnant patients.
Ultrasound
- No significant contraindications exist.
CT with or without contrast
- Contraindicated in a pregnant patient, especially in the first two trimesters
- Relative contraindication in allergy to contrast
- Relative contraindication in patients with renal failure
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.