Procedure

Elbow Joint Injection

Elbow Joint Injection, Elbow Joint Aspiration, Elbow Arthrocentesis, Radiohumeral Joint Injection, Radiohumeral Arthrocentesis

Overlying infection (e.g. Cellulitis, abscess)
Prosthetic Joints (consult orthopedics prior to Arthrocentesis)
Hemarthrosis is not significantly increased with antiplatelet agents, or INR <4-5

Needle (with 5-10 cc syringe)
1. Gauge
  1. Aspiration: 18 to 22
  2. Injection: 25 to 27
2. Length: 1.5 inches
Injection Solution
1. Lidocaine 1%: 3-5 ml
2. Corticosteroid options
  1. Methylprednisolone (40 mg/ml): 1-2 ml or
  2. Celestone Soluspan (3 mg/ml): 1-2 ml

Medial elbow approach is associated with increased risk of complication (Lateral approach is preferred)
1. Ulnar Nerve injury
2. Superior ulnar collateral artery injury
Position patient
1. Patient seated
2. Elbow flexed at 90 degrees
3. Forearm pronated (palm-side down)
Mark landmarks of lateral triangle
1. Consider Bedside Ultrasound
2. Lateral olecranon
3. Lateral epicondyle
4. Radial head
Prepare the skin surface
1. Mark the center of the lateral triange
2. Chlorhexidine or Povidone-Iodine
3. Sterile drape
4. Subdermal injection of Anesthetic at entry
Needle insertion
1. Insert needle perpendicular to skin
2. Needle inserted at center of lateral triangle (see above)
3. Needle aimed toward medial epicondyle
4. Redirect needle if bone reached
5. Aspirate for blood prior to injection