Equipment
Aspiration or injection of soft tissues may be performed as an outpatient procedure and does not require specialized equipment. [14] The following items are used:
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Needle, 25 or 27 gauge
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Readily available syringes for injection (3-5 mL)
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Methylprednisolone acetate 30-40 mg
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Lidocaine 1% (0.5-1 mL) without epinephrine
Patient Preparation
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.)
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Medial epicondyle.
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Injection site.
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Medial epicondyle injection.
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A 55-year-old woman with a long history of medial epicondylitis in whom several previous cortisone injections have failed. A multipuncture technique with attempted percutaneous tenotomy is performed to hopefully stimulate a healing inflammatory response. Video courtesy of James R Verheyden, MD.
