Equipment

Aspiration or injection of soft tissues may be performed as an outpatient procedure and does not require specialized equipment.^[15] The following equipment and agents should be available:

Needle, 25 or 27 gauge
Readily available syringes for injection (3-5 mL)
Methylprednisolone acetate 20-40 mg
Lidocaine 1% (0.5-1 mL) without epinephrine

Anesthesia

With regard to anesthesia, experienced clinicians often prefer to use topical ethyl chloride or no anesthetic at all. This is often appropriate for joint aspiration, in that the capsule is difficult to anesthetize, and a single quick needle thrust may be much less painful than the administration of local anesthesia.

Positioning

Place the patient in a comfortable supine position. This aids relaxation and guards against possible fainting.^[1] Have the patient flex the affected elbow to 90° with the hand tucked under the buttock. Mark the lateral epicondyle and radial head.^{[1, 2]}

Technique

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Media Gallery

Lateral epicondyle.
Injection of lateral epicondyle.
Patient with chronic lateral epicondylitis in whom several previous cortisone injections by different providers failed. Multipuncture lateral epicondyle injection is performed in effort to stimulate healing inflammatory response and completely detach partially torn extensor carpi radialis brevis tendon. Video courtesy of James R Verheyden, MD.