eMedicine Specialties > Clinical Procedures > Musculoskeletal Procedures

Injection, Lateral Epicondyle

Author: Ritu Khurana, MD, Chief of Rheumatology, Crozer Chester Medical Center
Contributor Information and Disclosures

Updated: Apr 12, 2009

Introduction

  • Lateral epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins of the extensor carpi radialis brevis and longus tendons (see image below).1,2,3,4
  • Though commonly known as tennis elbow, lateral epicondylitis may be caused by various sports and occupational activities.
  • The diagnosis of lateral epicondylitis is based upon a history of pain over the lateral epicondyle and the following findings on physical examination:
    • Local tenderness directly over the lateral epicondyle
    • Pain aggravated by resisted wrist extension and radial deviation
    • Decreased grip strength or pain aggravated by strong gripping
    • Normal elbow range of motion
  • Strain or tear of various portions of the extensor digitorum and extensor carpi radialis brevis muscles due to repetitive use results in chronic inflammation.5
  • The histopathology of the affected musculature reveals edema and fibroblast proliferation in the subtendinous space, tendinopathy with hypervascularity (particularly involving the extensor carpi radialis brevis tendon), and spur formation with a sharp longitudinal ridge on the lateral epicondyle.
  • Corticosteroids and other drugs often are injected in and around soft-tissue periarticular lesions to treat regional pain syndromes.
  • The principles and practice of inserting a needle into a joint cavity are very similar to the principles and practice of inserting a needle into a periarticular lesion.

Indications

  • Failure of conservative treatment
  • To shorten symptomatic period (long-term outcome is similar in patients who do or do not receive injection)6,7
  • To speed up recovery in high-performance athletes, although this is a controversial practice

Contraindications

  • Joint or soft-tissue aspirations and injections have few absolute contraindications.
  • The procedure should probably be avoided if the overlying skin or subcutaneous tissue is infected or if bacteremia is suspected.
  • The presence of a significant bleeding disorder or diathesis or severe thrombocytopenia may also preclude joint aspiration.
  • Aspiration of a joint with a prosthesis in it carries a particularly high risk of infection and is often best left to a surgeon using full aseptic techniques.
  • Lack of response to previous injections may be a relative contraindication.
  • If infection is suspected as the underlying cause of the musculoskeletal problem, injection of corticosteroids must be avoided for fear of exacerbating the infection. Corticosteroids are contraindicated in patients with septic arthritis.
  • Warfarin anticoagulation with international normalization ratio (INR) values in the therapeutic range is not a contraindication to joint or soft-tissue aspiration or injection.

More on Injection, Lateral Epicondyle

Overview: Injection, Lateral Epicondyle
Treatment & Medication: Injection, Lateral Epicondyle
Multimedia: Injection, Lateral Epicondyle
References
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References

  1. Wise C. Arthrocentesis and injection of joints and soft tissues. In:. In: Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB. Kelley's Textbook of Rheumatology. Vol 1. 7th ed. New York, NY: Saunders; 2004:Chap 47.

  2. Canoso, JJ. Evaluation, signs and symptoms. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Rheumatology. Vol 1. 3rd ed. St. Louis, Mo: Mosby; 2003:Chap 23.

  3. Burton JH. Acute disorders of the joints and bursae. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM. Emergency Medicine. 6th Edition. American College of Emergency Physicians (ACEP); 2004:Chapter 286.

  4. Bunata RE, Brown DS, Capelo R. Anatomic factors related to the cause of tennis elbow. J Bone Joint Surg Am. Sep 2007;89(9):1955-63. [Medline].

  5. Torp-Pedersen TE, Torp-Pedersen ST, Qvistgaard E, Bliddal H. Effect of glucocorticosteroid injections in tennis elbow verified on colour Doppler ultrasonography: evidence of inflammation. Br J Sports Med. Dec 2008;42(12):978-82. [Medline].

  6. Faro F, Wolf JM. Lateral epicondylitis: review and current concepts. J Hand Surg [Am]. Oct 2007;32(8):1271-9. [Medline].

  7. Johnson GW, Cadwallader K, Scheffel SB, Epperly TD. Treatment of lateral epicondylitis. Am Fam Physician. Sep 15 2007;76(6):843-8. [Medline].

  8. Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. Dec 1 2002;66(11):2097-100. [Medline]. [Full Text].

  9. Stephens MB, Beutler AI, O'Connor FG. Musculoskeletal injections: a review of the evidence. Am Fam Physician. Oct 15 2008;78(8):971-6. [Medline].

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Further Reading

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Keywords

lateral epicondylitis, tennis elbow, lateral epicondyle, joint injection, steroid injection, elbow injection, elbow steroid injection, elbow tenderness, elbow pain, elbow inflammation, lateral epicondylitis treatment, tennis elbow treatment, tennis elbow injection

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Contributor Information and Disclosures

Author

Ritu Khurana, MD, Chief of Rheumatology, Crozer Chester Medical Center
Ritu Khurana, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

Medical Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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