II. Indications: Refractory to conservative measures

  1. Osteoarthritis
  2. Rheumatoid Arthritis
  3. Gout
  4. Radial Head Fracture diagnosis
    1. Blood or fat globules on aspiration

III. Preparation

  1. Needle (with 5-10 cc syringe)
    1. Gauge: 18-22 to aspirate, 25 to inject
    2. Length: 1.5 inches
  2. Injection Solution
    1. Lidocaine 1%: 3-5 ml
    2. Corticosteroid options
      1. Methylprednisolone (40 mg/ml): 1-2 ml or
      2. Celestone Soluspan (3 mg/ml): 1-2 ml

IV. Technique

  1. Position patient
    1. Patient supine
    2. Elbow flexed at 45 degrees
    3. Hand resting in neutral position by thigh
  2. Mark landmarks of lateral triangle
    1. Lateral olecranon
    2. Lateral epicondyle
    3. Radial head
  3. Needle insertion
    1. Apply betadine or hibiclens to area
    2. Insert needle perpendicular to skin
      1. Needle inserted at center of lateral triangle
      2. Needle aimed toward medial epicondyle
      3. Redirect needle if bone reached
      4. Aspirate for blood prior to injection

V. References

  1. Pfenninger (1994) Procedures, Mosby, p. 1045
  2. Cardone (2002) Am Fam Physician 66(11):2097-100 [PubMed]

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