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Elbow Injection Technique | OrthoFixar 2024

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Procedure

Elbow Injection Technique

Content List

Elbow Injection with corticosteroid is used in case of acute or chronic capsulitis that causes pain in and around elbow joint.

Elbow Injection Equipment

  1. Syringe: 2.5 ml
  2. Needle: Blue, 23 gauge 1.25 inches (30 mm)
  3. Kenalog 40: 30 mg
  4. Lidocaine: 1.75 ml, 2%

Related Anatomy

The capsule of the elbow joint contains all three articulations – the radiohumeral, radioulnar and humeroulnar joints. The posterior approach into the small gap between the top of the head of the radius and the capitulum of the humerus is the safest and easiest.

Elbow Injection Technique

To perform the injection into the elbow joint, follow these steps:

  • Patient sits with elbow supported in pronation at 45 degrees of flexion
  • Identify gap of joint line above head of radius posteriorly by passively moving elbow into flexion and extension
  • Insert needle at midpoint of joint line parallel to top of head of radius, and penetrate capsule
  • Inject solution as a bolus.
Elbow steroid Injection
Elbow Injection Site

Aftercare

Begin early to increase the range of motion within the limits of pain using gentle stretching movements, especially into flexion. Passive mobilization techniques are effective in achieving full range but should be given with care so as not to traumatize the joint further.

Notes

Elbow Injection is not a very common, but may be useful after trauma or fracture of the radial head. If the cause of the symptoms is one or more loose bodies within the joint, the treatment is mobilization under strong traction. If the range is then improved by this but the pain persists, an elbow injection may be considered. Adolescents with loose bodies in the joint should be referred for advice on surgical removal.

If the joint is very degenerated, osteophytosis might be present around the joint margin, making entry with the needle more difficult. Deposition of a small amount of the solution into the capsule enables the clinician to pepper around the joint line, with minimal discomfort to the patient. Some clinicians favour the posterior approach to the joint, inserting the needle at the top of the olecranon and angling obliquely distally but this is slightly more difficult to perform.

Biceps Bursa & Tendon Insertion Injection

Biceps Bursa & Tendon Insertion Injection with corticosteroid is used in case of chronic tendinitis or bursitis.

biceps injection
Biceps Bursa Injection

Equipment

  1. Syringe:
    • Tendon, 1 ml
    • Bursa, 2 ml
  2. Needle: Blue, 23 gauge, 1 inch (25 mm)
  3. Kenalog 40:
    • Tendon, 10 mg
    • Bursa, 20 mg
  4. Lidocaine:
    • Tendon, 0.75 ml, 2%
    • Bursa, 1.5 ml, 2%
  5. Total volume:
    • Tendon, 1 ml
    • Bursa, 2 ml

Anatomy

Although the biceps can be affected at any point along its length, the insertion into the radial tuberosity on the anteromedial aspect of the shaft of the radius is particularly vulnerable. A small bursa lies at this point and can be inflamed together with the tendon or on its own. The insertion of the biceps is identified by following the path of the tendon distal to the cubital crease while the patient resists elbow flexion. The patient then relaxes the muscle and the tuberosity can be palpated on the ulnar side of the radius while passively pronating and supinating the forearm. The site is always very tender to palpation, even in the normal elbow.

Technique

  • Patient lies face down, with arm extended and palm flat. Fix humerus on the table and passively fully pronate forearm. This brings radial tuberosity around to face posteriorly
  • Identify radial tuberosity at two fingers distal to radial head
  • Insert needle perpendicularly to touch bone
  • Pepper solution into tendon or as a bolus into bursa, or both, as necessary.
bicep steroid injection

The patient rests until pain free before beginning graded biceps strengthening and a stretching routine. The cause of the overuse should also be addressed.

Differentiation between bursitis and tendinitis is often difficult. If there is more pain on passive flexion and pronation of the elbow than on resisted flexion, together with extreme sensitivity to palpation, the bursa is more likely to be the cause.

If a double lesion is suspected, infiltrate the bursa first and reassess a week later. The tendon can then be injected if necessary

References

  1. Rowe CR. Injection technique for the shoulder and elbow. Orthop Clin North Am. 1988 Oct;19(4):773-7. PMID: 3174085.
  2. Injection Techniques in Musculoskeletal Medicine. A Practical Manual for Clinicians In Primary And Secondary Care. Fifth Edition
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