II. Indications: Refractory to conservative measures

III. Efficacy

  1. Safe and effective for 2-6 weeks after injection
    1. Highly effective in short-term (92% improve)
    2. Reduces pain and improves grip strength
    3. Hay (1999) BMJ 319:964-8 [PubMed]
  2. Benefits do not persist beyond 6 weeks
    1. Outcomes are the same or worse at 6 months than with conservative therapy above
    2. Smidt (2002) Lancet 359:657-62 [PubMed]

IV. Preparation

  1. Needle 25 gauge, 1 inch long (with 5 cc syringe)
  2. Injection Solution
    1. Lidocaine 1%: 1 ml
    2. Corticosteroid options
      1. Methylprednisolone (40 mg/ml): 1 ml or
      2. Celestone Soluspan (3 mg/ml): 1 ml

V. Technique

  1. Position patient (supine)
    1. Lateral Epicondylitis
      1. Arm adducted at side
      2. Elbow flexed to 45 degrees
      3. Wrist pronated
    2. Medial Epicondylitis
      1. Rest arm in comfortable abducted position
      2. Elbow flexed to 45 degrees
      3. Wrist supinated
  2. Mark landmark for injection
  3. Mark point of maximal tenderness over epicondyle
  4. Needle insertion
    1. Apply betadine or hibiclens to area
    2. Insert needle perpendicular to skin
      1. Needle inserted at point of maximal tenderness
      2. Insert to bone, then withdraw 1-2 mm
      3. Inject Corticosteroid solution slowly

VI. Timing

  1. May repeat 2-3 times over several months to a year

VII. Adverse Effects

  1. See Corticosteroid Injection
  2. Ulnar Nerve injury (Medial Epicondyle Injection)
  3. Weakening of tendon insertion

VIII. References

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

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