A 58-year-old man had painless fluctuation in the elbow for more than 2 weeks. The skin over the elbow was not warm or red, and there was no pain on palpation. Aseptic bursitis must be differentiated from acute septic bursitis where the skin over the elbow is red and tender (video ). Puncture of the bursa yielded reddish, but otherwise clear fluid. Methylprednisolone was injected into the bursa.