Elbow, Wrist Injections
Elbow Injections
Elbow pain, especially around the tendons, can be a debilitating issue that affects your ability to move and carry out daily activities. Two common causes of elbow pain are medial epicondylitis (also known as “golfer’s elbow”) and lateral epicondylitis (also known as “tennis elbow”). Both conditions are related to inflammation and microtears in the tendons that attach to the bones on the inside (medial) or outside (lateral) of the elbow. One of the effective treatments for these conditions is the use of steroid injections under ultrasound guidance. These injections can help manage pain, reduce inflammation, and promote healing.
This guide will explain what these injections are, how they are performed, why they are done, their benefits, and other important aspects of this treatment.
What is Medial Epicondylitis and Lateral Epicondylitis?
- Medial Epicondylitis (Golfer’s Elbow): This condition involves inflammation of the tendons on the inside of the elbow, where the forearm muscles attach to the medial epicondyle of the humerus (the inner bony prominence of the elbow). It is typically caused by overuse of the forearm muscles, leading to tiny tears in the tendons. Activities that involve repetitive wrist flexion or gripping motions, such as golfing, can lead to this condition.
- Lateral Epicondylitis (Tennis Elbow): This condition affects the tendons on the outside of the elbow at the lateral epicondyle, which is the bony prominence on the outer side of the elbow. It is most commonly caused by repetitive motions, especially those that involve extension of the wrist or gripping, such as playing tennis or other racquet sports. However, it can also result from repetitive work or hobbies involving the wrist and forearm.
Both conditions lead to pain and tenderness around the elbow, and if left untreated, they can result in chronic pain and weakness in the arm.
What is Medial Epicondylitis and Lateral Epicondylitis?
- Medial Epicondylitis (Golfer’s Elbow): This condition involves inflammation of the tendons on the inside of the elbow, where the forearm muscles attach to the medial epicondyle of the humerus (the inner bony prominence of the elbow). It is typically caused by overuse of the forearm muscles, leading to tiny tears in the tendons. Activities that involve repetitive wrist flexion or gripping motions, such as golfing, can lead to this condition.
- Lateral Epicondylitis (Tennis Elbow): This condition affects the tendons on the outside of the elbow at the lateral epicondyle, which is the bony prominence on the outer side of the elbow. It is most commonly caused by repetitive motions, especially those that involve extension of the wrist or gripping, such as playing tennis or other racquet sports. However, it can also result from repetitive work or hobbies involving the wrist and forearm.
Both conditions lead to pain and tenderness around the elbow, and if left untreated, they can result in chronic pain and weakness in the arm.
What Are Steroid Injections?
A steroid injection is a procedure in which a corticosteroid medication (often combined with a local anesthetic) is injected directly into the inflamed area around the tendon. Corticosteroids are powerful anti-inflammatory drugs that help reduce inflammation and pain. The goal of the injection is to provide pain relief, promote healing, and allow the patient to regain function in the affected arm.
Why Are Steroid Injections Done for Epicondylitis?
Steroid injections are often considered when conservative treatments such as rest, physical therapy, bracing, and nonsteroidal anti-inflammatory drugs (NSAIDs) do not provide sufficient relief for symptoms of epicondylitis. These injections can be particularly helpful for patients who have not had improvement after several weeks or months of conservative treatment.
The injection works by reducing inflammation in the tendons, which can help alleviate pain, reduce swelling, and enable the tendons to heal. While it doesn’t cure the underlying problem (the tendon degeneration or microtears), it can provide significant symptomatic relief, especially when other methods have not been effective.
How Are Steroid Injections Done Under Ultrasound Guidance?
- Preparation:
- The patient is asked to sit comfortably, with the arm exposed to the physician. For lateral epicondylitis, the patient may be asked to extend the arm, while for medial epicondylitis, the arm may be flexed.
- The skin is cleaned with an antiseptic solution to minimize the risk of infection.
- The physician will apply a special gel to the elbow to help with ultrasound imaging. This gel ensures better contact between the ultrasound probe and the skin.
- Ultrasound Imaging:
- The physician uses an ultrasound machine, which emits high-frequency sound waves that produce real-time images of the internal structures. The ultrasound allows the doctor to visualize the tendon and surrounding tissue in great detail.
- The physician will examine the inflamed tendon, guiding the needle to the exact location where the corticosteroid is needed. This step ensures the injection is delivered precisely into the affected area.
- Injection:
- Once the needle is positioned correctly under ultrasound guidance, the physician injects the corticosteroid and, often, a small amount of local anesthetic to numb the area. The local anesthetic provides immediate relief, while the steroid takes several hours to start working and may continue to reduce inflammation over the following days.
- The needle is withdrawn, and the area is cleaned.
- Post-Injection Care:
- The patient may be asked to rest the arm for a few hours but can generally resume most normal activities the next day, avoiding heavy lifting or activities that strain the elbow.
- Patients are often advised to follow up with physical therapy to help strengthen the muscles around the elbow and prevent future injury.
Benefits of Steroid Injections
- Pain Relief: The primary benefit of a steroid injection is pain relief. Steroids reduce inflammation, which in turn decreases pain. This can help you return to daily activities with less discomfort.
- Reduced Inflammation: By decreasing inflammation in the tendons, the injections help to break the cycle of inflammation and damage to the tendons, allowing the tissue to heal more effectively.
- Improved Function: As pain decreases and inflammation is controlled, patients can regain better mobility and function in their elbow and arm. This often leads to an improved quality of life and a greater ability to engage in work or recreational activities.
- Non-Surgical Treatment: Steroid injections are a non-invasive option that can provide relief without the need for surgery. This is particularly beneficial for patients who are not ready for or do not need surgery.
- Quick Recovery: Steroid injections are relatively quick procedures, and most patients experience improvement in their symptoms within a few days. Recovery time is typically minimal.
While steroid injections can be highly effective, they do come with some risks and considerations.
Steroid injections under ultrasound guidance can be a highly effective treatment for medial and lateral epicondylitis, providing significant relief from pain and inflammation. By accurately targeting the affected tendon, ultrasound ensures the medication is delivered precisely where it is needed, enhancing the effectiveness of the injection and minimizing risks.
While steroid injections can offer significant pain relief and improved function, they are typically part of a broader treatment plan, which may include physical therapy, rest, and ergonomic modifications. If you’re experiencing persistent elbow pain despite conservative treatments, a steroid injection may be an option to consider. Your healthcare provider can help determine the best course of action based on your specific condition and needs.
