II. Indications: Refractory to conservative measures
III. Efficacy
- Safe and effective for 2-6 weeks after injection
- Highly effective in short-term (92% improve)
- Reduces pain and improves grip strength
- Hay (1999) BMJ 319:964-8 [PubMed]
- Benefits do not persist beyond 6 weeks
- Outcomes are the same or worse at 6 months than with conservative therapy above
- Smidt (2002) Lancet 359:657-62 [PubMed]
IV. Preparation
- Needle 25 gauge, 1 inch long (with 5 cc syringe)
- Injection Solution
- Lidocaine 1%: 1 ml
- Corticosteroid options
- Methylprednisolone (40 mg/ml): 1 ml or
- Celestone Soluspan (3 mg/ml): 1 ml
V. Technique
- Position patient (supine)
- Mark landmark for injection
- Mark point of maximal tenderness over epicondyle
- Needle insertion
- Apply Betadine or Hibiclens to area
- Insert needle perpendicular to skin
- Needle inserted at point of maximal tenderness
- Insert to bone, then withdraw 1-2 mm
- Inject Corticosteroid solution slowly
VI. Timing
- May repeat 2-3 times over several months to a year
VII. Adverse Effects
- See Corticosteroid Injection
- Ulnar Nerve injury (Medial Epicondyle Injection)
- Weakening of tendon insertion
VIII. References
- Pfenninger (1994) Procedures, Mosby, p. 1045
- Cardone (2002) Am Fam Physician 66(11):2097-100 [PubMed]