Elbow Joint Injection

Acute or chronic capsulitis

Causes and findings:
• Degenerative, inflammatory or traumatic arthropathies
• Occasionally heavy overuse, e.g. tennis, fencing
• Pain in and around elbow joint
• Painful limitation in the capsular pattern - more: loss of flexion than extension with a hard end feel

Equipment:
Syringe - 1ml
Needle - 23G 1.25 inches (30mm) blue
Kenalog 40 - 20 mg
Lidocaine - 1.5 ml 2%
Total volume - 2 ml

Anatomy:
The capsule of the elbow joint contains all three articulations - the radiohumeral, radioulnar and humeroulnar joints. The posterior approach into the small gap between the top of the head of the radius and the capitulum of the humerus is the safest and easiest.

Technique:
• Patient sits with elbow supported in pronation at 450 of flexion
• Identify gap of joint line above head of radius posteriorly by passively moving elbow into flexion and extension
• Insert needle at mid-point of joint line parallel to the top of the head of radius, and penetrate capsule
• Inject solution as a bolus

Aftercare:
After a couple of days the patient should start increasing range of motion within the limits of pain using gentle stretching movements, especially into
flexion. Passive mobilization techniques are effective in achieving full range but should be given with care in order not to further traumatize the joint.

Comments:
This is not a very common injection but may be useful after trauma or fracture of the radial head. If the cause of the symptoms is one or more loose bodies within the joint, the treatment is mobilization under strong traction. If the range is improved by this but the pain persists, an injection may be considered. Adolescents with loose bodies in the joint should be referred for surgical removal.

Alternative approaches:
If the joint is very degenerated, osteophytosis might be present around the joint margin, making entry with the needle more difficult. Deposition of a small amount of the solution into the capsule enables the clinician to 'walk' around the joint line with minimal discomfort to the patient. Some clinicians favour the posterior approach to the joint, inserting the needle at the top of the olecranon and angling obliquely distally.