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