What Is a Medial Epicondyle Injection For?

In a medial epicondyle injection, medications are injected into the elbow joint to treat diseases, such as arthritis.

A medial epicondyle injection is a procedure in which medications are injected into the elbow joint to treat diseases of the joint.

There are different types of medial epicondyle injections. The most common type of an intra-articular medial epicondyle injection is with corticosteroids. Other agents used are hyaluronic acid, infliximab botulinum neurotoxin (Botox), and platelet-rich plasma (PRP).

Elbow joint (medial epicondyle) pain and stiffness can be debilitating and difficult to treat. Elbow conditions may negatively affect the quality of life and emotional well-being. Approaches used for treating elbow pain include 

• exercise, 
• physiotherapy, 
• medications, 
• medial epicondyle injections, and 
• surgery.

Medial epicondyle pain can result from

• ligament or tendon injury,
• fracture,
• cartilage loss in osteoarthritis, and
• inflammatory conditions such as inflammatory arthritis or septic arthritis.

Medial epicondyle pain can also be due to joint malalignment or dysfunction and referred pain from other areas. Medial epicondyle diseases can be diagnosed based on clinical presentation, radiographic tests and joint aspiration (arthrocentesis).

A medial epicondyle injection is used to treat various diseases of the elbow joint. The type of medication injected and frequency depend on the condition being treated. Based on the diagnosis and extent of the disease, the doctor would recommend a treatment plan.

Indications for the various agents used for medial epicondyle injections are mentioned below:

Steroid injections

These help to relieve pain and inflammation in individuals with

• Osteoarthritis
• Juvenile idiopathic arthritis
• Psoriatic arthritis
• Acute monoarticular gout or pseudogout
• Rheumatoid arthritic elbows
• Infliximab injections
• Infliximab suppresses inflammation and can be used to treat the following:
• Elbow monoarthritis
• Rheumatoid arthritis
• Spondyloarthropathy (ankylosing spondylitis)

Infliximab injections

Infliximab suppresses inflammation and can be used to treat the following:

• Elbow monoarthritis
• Rheumatoid arthritis
• Spondyloarthropathy (ankylosing spondylitis)

Hyaluronic acid injections

Hyaluronic acid (HA) is naturally present in the joints, eyes, and skin. HA levels decrease with age, leading to joint friction and arthritis. HA elbow injections lubricate the joint, decrease friction, decrease impact, delay joint aging, and reduce pain and stiffness. HA is used for treating:

• Elbow osteoarthritis 
• Rheumatoid arthritis and osteoarthritis
• Botox injections
• Botox inhibits the sensory neurons causing pain. Hence, joint function improves, significantly reducing pain and stiffness. 
• Platelet-rich plasma injections
• Platelet-rich plasma is obtained from the patient’s own blood. It contains growth factors that stimulate collagen formation and lubricate the joint. Platelet-rich plasma can improve joint function and reduce pain.

Botox injections

• Botox inhibits the sensory neurons causing pain. Hence, joint function improves, significantly reducing pain and stiffness. 

Platelet-rich plasma injections

• Platelet-rich plasma is obtained from the patient’s own blood. It contains growth factors that stimulate collagen formation and lubricate the joint. Platelet-rich plasma can improve joint function and reduce pain.

A medial epicondyle injection is a quick procedure and may be performed under local anesthesia to avoid pain. A needle of an appropriate size and length connected to a syringe is introduced into the joint, and the medicine is injected. Radiological guidance may sometimes be used to aid in injection.

After the procedure, the patient would need to rest for a few minutes, soon after which they can resume normal activities. Patients may experience pain, swelling, and bruising, which will get resolved in a few days. Ice packs and pain killers can help reduce pain and bruising.

It is advised to keep the area clean and dry for 48 hours after the injection to avoid complications.

The time taken for medial epicondyle injections to work depends on the medicine injected. Different medications have different durations of onset and longevity.

• Steroids: These take two to three days following the injection for patients to observe the relief of symptoms. In case of severe joint disease, it may take longer for the effects to begin. Steroid elbow injections are usually injected three to four times a year because the effects last for six to 12 weeks.
• Hyaluronic acid: This takes three to four weeks to observe the effects of pain relief after the initial injection. The effects last for two to six months, after which the injection would have to be repeated.
• Platelet-rich plasma: This takes longer for its action on the joints to begin, which is approximately six months, but the results are more superior and effects last longer than those of hyaluronic acid.
• Infliximab: This may take a few days up to two to six weeks for the effects to begin after the first treatment. The treatment can be repeated every eight weeks.
• Botox: This takes three to 14 days to observe pain relief, and the results last for approximately three months.

Complications are rare and can usually be resolved. Some common complications are:

• Infection
• Bleeding
• Swelling
• Risk of tendon rupture due to frequent injections
• A hypopigmented (light-colored) patch on the skin
• Osteoporosis of bones (thinning of bones) due to serial injections
• Nerve damage due to injections