What type of specialist performs aspiration procedures for conditions like elbow bursitis?

Aspiration Procedures for Elbow Bursitis

Aspiration procedures for conditions like elbow bursitis can be performed by multiple specialists including radiologists (using image guidance), orthopedic surgeons, rheumatologists, sports medicine physicians, and emergency medicine physicians, with the American College of Radiology recommending image-guided aspiration when possible to ensure accurate needle placement and minimize complications. 1, 2, 3

Specialists Who Perform Aspiration

Radiologists (Interventional)

• Radiologists perform image-guided aspirations using ultrasound, fluoroscopy, or CT guidance to confirm proper needle placement and reduce the risk of contaminating adjacent tissues. 1, 2, 3
• Image guidance is particularly valuable when targeting specific compartments or when clinical landmarks are unclear. 1
• The American College of Radiology explicitly states that imaging-guided aspiration procedures provide a minimally invasive means to sample fluid from joints and bursae suspected of infection. 1

Orthopedic Surgeons

• Orthopedic surgeons commonly perform bursal aspirations, particularly when surgical intervention may be needed for recalcitrant cases or when septic bursitis requires surgical wash-out. 4, 5, 6
• They typically manage cases that fail conservative treatment or require operative debridement. 4, 5

Rheumatologists

• Rheumatologists routinely perform joint and bursal aspirations as part of their diagnostic workup for inflammatory conditions, particularly when crystal disease (gout or pseudogout) is in the differential diagnosis. 1, 2, 3
• High-frequency ultrasound (10 MHz and above) can be used at the bedside by rheumatologists to guide aspiration procedures. 1, 2

Emergency Medicine Physicians

• Emergency physicians perform bursal aspirations when septic bursitis is suspected and immediate diagnosis is required to prevent septicemia. 5, 6
• Aspiration in the emergency setting should be followed by prompt initiation of antibiotics if infection is confirmed. 5, 6

Sports Medicine Physicians

• Sports medicine specialists manage both acute traumatic and chronic microtraumatic bursitis, performing aspirations when clinically indicated. 4, 6

Key Clinical Considerations

When Image Guidance Is Recommended

• The American College of Radiology recommends image-guided aspiration (ultrasound or fluoroscopy) when septic bursitis is suspected to ensure accurate needle placement. 1, 2, 3
• Image guidance is particularly important for deep bursae (like iliopsoas) or when there is concern for contaminating adjacent tissues or joints. 1, 2
• Ultrasound guidance can be performed at the bedside and allows real-time visualization of needle placement. 1, 2

When Aspiration Should Be Performed

• Aspiration is indicated when clinical features cannot reliably distinguish septic from aseptic bursitis, especially when crystal disease is in the differential diagnosis. 2, 3, 6
• Complicated presentations requiring aspiration include cellulitis extending beyond the bursa, concern for underlying osteomyelitis, or patients with prosthetic joints or hardware near the affected bursa. 3, 6
• Joint aspiration should not be delayed to obtain advanced imaging studies when septic arthritis or septic bursitis is suspected. 1, 7

Important Pitfall

• While aspiration can be performed without imaging guidance if the bursa is distended and easily palpable, image guidance (ultrasound or fluoroscopy) reduces complications and ensures proper sampling. 1, 2, 3
• The most dangerous error is failing to perform aspiration when infection is suspected, as this can lead to permanent joint destruction, septicemia, and increased mortality. 7, 5, 6