How Do You Inject Lateral Epicondylitis?

A lateral epicondyle injection injects corticosteroid medication to reduce pain and inflammation in lateral epicondylitis (tennis elbow).

Lateral epicondylitis, or tennis elbow, is a painful condition of the elbow due to its overuse or strenuous activity that causes pain in the elbow and arm. 

As the name suggests, tennis elbow may be caused by playing racquet sports, such as tennis. It is not, however, restricted to racquet sports and may be caused due to several other repeated activities such as weightlifting, carpentry, painting, typing, raking, and knitting.

It is caused by the inflammation of the tendons (bands of tissue that connect a muscle to a bone) that join the forearm muscles on the outside of the elbow.

Because of overuse and repeated motion, the forearm muscles and tendons become damaged, leading to pain and tenderness on the outside of the elbow. It is one of the most common reasons for long-term (chronic) elbow pain. Although tennis elbow may be observed in people of any age, it is most common in people around 40 years of age.

It presents as pain and tenderness in the bony knob on the outside of the elbow. This knob (lateral epicondyle) is where the injured tendons attach to the bone. Pain may also be felt on the upper or lower arm. Pain is increased upon:

• Lifting something
• Making a fist or grasping an object
• Opening a door
• Shaking hands
• Raising the hand 
• Straightening the wrist

Treatment may be conservative such as icing the elbow, using an elbow strap, painkillers, physiotherapy, and injections in the lateral epicondyle. If conservative treatment fails to provide relief, surgery may be considered.

• A lateral epicondyle injection is performed as an outpatient procedure.
• The patient lies in a comfortable position. 
• The patient flexes (bends) the affected elbow to 90° with the hand tucked under the buttock.
• The doctor identifies the landmarks on the elbow for guiding the needle.
• The doctor cleans the skin with antiseptics.
• The doctor applies a local anesthetic (such as ethyl chloride) to the skin. Experienced clinicians may administer it with topical anesthesia or no anesthesia at all.
• After numbing the skin, the doctor inserts a thin needle directly over the center of the epicondyle, either perpendicular to the skin (if the patient has sufficient subcutaneous fat) or at a 45° angle to a depth of one-fourth to half an inch.
• The doctor injects the corticosteroid medication (to reduce the pain and inflammation) and local anesthetic into the origin of the tendon and the surrounding tissue causing pain and discomfort.
• At the end of the injection, the doctor withdraws the needle swiftly.
• The doctor applies light pressure to the injection site.
• After injection, the hand may be moved to ascertain the proper delivery of the medication.
• The doctor may apply a small bandage to the injection site.

The procedure is quite safe with few complications such as:

• Infection
• Tendonitis (inflammation of the tendon)
• Nerve injury
• Transient increase in pain
• Skin discoloration
• Skin atrophy (wasting)
• Hormonal imbalances
• Localized osteoporosis (a medical condition in which the bones become brittle and fragile)
• Rupture of the tendon because of repeated injections