Equipment

Aspiration or injection of soft tissues may be performed as an outpatient procedure and does not require specialized equipment.^[18] The following items are used:

Needle, 25 or 27 gauge
Readily available syringes for injection (3-5 mL)
Methylprednisolone acetate 30-40 mg
Lidocaine 1% (0.5-1 mL) without epinephrine

Anesthesia

Experienced physicians often prefer to use topical ethyl chloride or no anesthetic at all. The latter is often appropriate for joint aspiration; the capsule is difficult to anesthetize, and a single quick needle thrust may be much less painful than the administration of local anesthesia.

Positioning

Place the patient in a comfortable supine position; this facilitates relaxation and guards against possible fainting.^[3] Have the patient flex the affected elbow to 90º with 90º of shoulder rotation. Mark the medial epicondyle and the olecranon process. (See the image below.)

Medial epicondyle injection site.

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Technique

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Boden AL, Scott MT, Dalwadi PP, Mautner K, Mason RA, Gottschalk MB. Platelet-rich plasma versus Tenex in the treatment of medial and lateral epicondylitis. J Shoulder Elbow Surg. 2019 Jan. 28 (1):112-119. [QxMD MEDLINE Link].
Bohlen HL, Schwartz ZE, Wu VJ, Thon SG, Finley ZJ, O'Brien MJ, et al. Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis. Orthop J Sports Med. 2020 Mar. 8 (3):2325967120908952. [QxMD MEDLINE Link]. [Full Text].
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Lee SS, Kang S, Park NK, Lee CW, Song HS, Sohn MK, et al. Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis. Ann Rehabil Med. 2012 Oct. 36 (5):681-7. [QxMD MEDLINE Link]. [Full Text].
Hume PA, Reid D, Edwards T. Epicondylar injury in sport: epidemiology, type, mechanisms, assessment, management and prevention. Sports Med. 2006. 36 (2):151-70. [QxMD MEDLINE Link].
Dooley P, Martin R. Corticosteroid injections and arthrocentesis. Can Fam Physician. 2002 Feb. 48:285-92. [QxMD MEDLINE Link]. [Full Text].
Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. 2002 Dec 1. 66 (11):2097-100. [QxMD MEDLINE Link]. [Full Text].
Degen RM, Cancienne JM, Camp CL, Altchek DW, Dines JS, Werner BC. Patient-related risk factors for requiring surgical intervention following a failed injection for the treatment of medial and lateral epicondylitis. Phys Sportsmed. 2017 Nov. 45 (4):433-437. [QxMD MEDLINE Link].
Vinod AV, Ross G. An effective approach to diagnosis and surgical repair of refractory medial epicondylitis. J Shoulder Elbow Surg. 2015 Aug. 24 (8):1172-7. [QxMD MEDLINE Link].
Birnbaum A, Yoon MY, Struhl S. Serial saline solution injections for the treatment of lipoatrophy and depigmentation after corticosteroid injection for medial epicondylitis. JSES Int. 2020 Dec. 4 (4):1002-1005. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Medial epicondyle.
Medial epicondyle injection site.
Medial epicondyle injection.
Medial epicondyle injection. Patient is 55-year-old woman with long history of medial epicondylitis in whom several previous cortisone injections have failed. Multipuncture technique with attempted percutaneous tenotomy is performed in hope of stimulating healing inflammatory response. Video courtesy of James R Verheyden, MD.