Lateral Epicondyle Injection

Updated: Jun 01, 2017
  • Author: Ritu Khurana, MD; Chief Editor: Erik D Schraga, MD  more...
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Overview

Background

Lateral epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins of the extensor carpi radialis brevis and longus tendons (see image below). [1, 2, 3, 4]

Lateral epicondyle. Lateral epicondyle.

Although lateral epicondylitis is commonly known as tennis elbow, it may be caused by a variety of sports and occupational activities.

The diagnosis of lateral epicondylitis is based upon a history of pain over the lateral epicondyle and the following findings on physical examination:

  • Local tenderness directly over the lateral epicondyle [5]
  • Pain aggravated by resisted wrist extension and radial deviation
  • Decreased grip strength or pain aggravated by strong gripping
  • Normal elbow range of motion

Strain or tear of various portions of the extensor digitorum and extensor carpi radialis brevis muscles due to repetitive use results in chronic inflammation. [6]

The histopathology of the affected musculature reveals edema and fibroblast proliferation in the subtendinous space, tendinopathy with hypervascularity (particularly involving the extensor carpi radialis brevis tendon), and spur formation with a sharp longitudinal ridge on the lateral epicondyle.

Corticosteroids and other drugs often are injected in and around soft-tissue periarticular lesions to treat regional pain syndromes. In a randomized controlled trial, Dojode concluded that autologous blood injection is efficient as compared with corticosteroid injection and offers fewer side effects and a minimal recurrence rate. [7]  Several studies have suggested that injection of platelet-rich plasma is effective in cases of recalcitrant lateral epicondylitis. [8, 9]

The principles and practice of inserting a needle into a joint cavity are very similar to those of inserting a needle into a periarticular lesion.

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Indications

Indications for lateral epicondyle injection include the following:

  • Failure of conservative treatment
  • Shortening the symptomatic period (long-term outcome is similar whether patients receive injection or not) [10, 11]
  • Speeding up recovery in high-performance athletes (though this is a controversial practice)
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Contraindications

Joint or soft-tissue aspirations and injections have few absolute contraindications. The procedure should probably be avoided if the overlying skin or subcutaneous tissue is infected or if bacteremia is suspected. The presence of a significant bleeding disorder or diathesis or severe thrombocytopenia may also preclude joint aspiration. Aspiration of a joint with a prosthesis in it carries a particularly high risk of infection and is often best left to a surgeon using full aseptic techniques. Lack of response to previous injections may be a relative contraindication.

If infection is suspected as the underlying cause of the musculoskeletal problem, injection of corticosteroids must be avoided for fear of exacerbating the infection. Corticosteroids are contraindicated in patients with septic arthritis.

Warfarin anticoagulation with international normalized ratio (INR) values in the therapeutic range is not a contraindication for joint or soft-tissue aspiration or injection.

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