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
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