Elbow workup : multiple pathologies
Referral for aspiration of the swollen right olecranon bursa following trauma. The patient was a 29 yo old right-handed male plumber. Clinical assessment and questioning of the patient revealed a swollen but non-tender olecranon bursa, finger drop and radial deviation of the wrist on extension, pain on compression over the right arcade of Frohse but not the left, ulnar neuropathy. No previous imaging, so proceeded with a complete workup of his right elbow.
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Olecranon bursitis (student's elbow)Fluid within the olecranon bursa and surrounding hyperaemia. The fluid was aspirated and sent for pathological analysis the following day.
Ultrasound revealed: student's elbow (olecranon bursitis), acute medial epicondylitis, chronic lateral epicondylitis, posterior interosseous nerve entrapment at the arcade of Frohse, a small posterior joint effusion, bilateral dislocation of the ulnar nerve over the medial epicondyle on elbow extension implying congenital rather than traumatic absence of the Osborn retinacula.
The PIN entrapment explains the finger drop and radial deviation of the wrist on extension. The dislocation of the ulnar nerve (a form of cubital tunnel syndrome) and being right-handed may explain the right-sided ulnar neuropathy.
The tricepsand biceps tendon insertions were unremarkable as were the anterior joints, median nerve and the anterior, posterior and oblique ulnar collateral ligaments.
In light of the posterior joint effusion (and trauma) an X-ray was performed. It was unremarkable aside from the swelling at the olecranon bursa.
The olecranon bursa was drained the following day and sent for pathology. The results showed that the fluid was blood. No fluid, leucocytes or organisms were detected.