Elbow Joint Injection

Aka: Elbow Joint Injection, Elbow Joint Aspiration, Elbow Arthrocentesis, Radiohumeral Joint Injection, Radiohumeral Arthrocentesis

1. See Also
   1. Joint Injection
   2. Arthrocentesis
2. Indications: Injection (Refractory to conservative measures)
   1. Osteoarthritis
   2. Rheumatoid Arthritis
   3. Gout
   4. Radial Head Fracture diagnosis
      1. Blood or fat globules on aspiration
3. Indications: Aspiration
   1. Septic Arthritis
   2. Acute Monoarthritis
4. Contraindications
   1. Overlying infection (e.g. Cellulitis, abscess)
   2. Prosthetic Joints (consult orthopedics prior to Arthrocentesis)
   3. Hemarthrosis is not significantly increased with antiplatelet agents, or INR <4-5
5. Preparation
   1. Needle (with 5-10 cc syringe)
      1. Gauge
         1. Aspiration: 18 to 22
         2. Injection: 25 to 27
      2. Length: 1.5 inches
   2. Injection Solution
      1. Lidocaine 1%: 3-5 ml
      2. Corticosteroid options
         1. Methylprednisolone (40 mg/ml): 1-2 ml or
         2. Celestone Soluspan (3 mg/ml): 1-2 ml
6. Technique: Lateral Elbow Approach
   1. Medial elbow approach is associated with increased risk of complication (Lateral approach is preferred)
      1. Ulnar Nerve injury
      2. Superior ulnar collateral artery injury
   2. Position patient
      1. Patient seated
      2. Elbow flexed at 90 degrees
      3. Forearm pronated (palm-side down)
   3. Mark landmarks of lateral triangle
      1. Consider Bedside Ultrasound
      2. Lateral olecranon
      3. Lateral epicondyle
      4. Radial head
   4. Prepare the skin surface
      1. Mark the center of the lateral triange
      2. Chlorhexidine or Povidone-Iodine
      3. Sterile drape
      4. Subdermal injection of Anesthetic at entry
   5. Needle insertion
      1. Insert needle perpendicular to skin
      2. Needle inserted at center of lateral triangle (see above)
      3. Needle aimed toward medial epicondyle
      4. Redirect needle if bone reached
      5. Aspirate for blood prior to injection
7. Complications
   1. See Intra-articular Injection
8. References
   1. Mohammadieh (2017) Crit Dec Emerg Med 31(7):12-3
   2. Pfenninger (1994) Procedures, Mosby, p. 1045
   3. Cardone (2002) Am Fam Physician 66(11):2097-100 [PubMed]