What is the treatment for a trigger injection to the lateral (outer) or medial (inner) epicondyle of the elbow?

From the Guidelines

Trigger point injection to the elbow epicondyle is not recommended as a first-line treatment for lateral epicondylopathy, as corticosteroid injections do not change long-term outcomes of pain 1. When considering treatment for lateral or medial epicondylitis, it is essential to weigh the benefits and limitations of each option.

• The use of corticosteroid injections for lateral epicondylopathy has been shown to be more effective than NSAIDs in the acute phase, but this benefit does not extend to long-term outcomes 1.
• Orthotics are commonly used, although their effectiveness is not well established due to a lack of definitive conclusions from existing clinical trials 1.
• Extracorporeal shock wave therapy has demonstrated mixed benefits for lateral elbow pain, making it a less reliable option 1. In clinical practice, a more effective approach may involve a combination of physical therapy, activity modification, and other conservative measures, reserving trigger point injections for cases where these measures have failed.
• It is crucial to prioritize treatments that address the underlying causes of the condition and promote long-term recovery, rather than relying solely on injections or other temporary solutions.
• By taking a comprehensive approach to treatment, clinicians can help patients achieve significant pain relief and improve their overall quality of life.

From the FDA Drug Label

Epicondylitis may be treated by infiltrating the preparation into the area of greatest tenderness. The trigger injection to elbow epicondyle can be done by infiltrating triamcinolone acetonide into the area of greatest tenderness, as stated in the drug label 2.

• The dose is not specified for this particular condition, but for intra-articular administration, the initial dose is 2.5 mg to 5 mg for smaller joints and from 5 mg to 15 mg for larger joints, depending on the specific disease entity being treated 2.
• It is essential to use strict aseptic technique and careful injection technique to avoid entering a blood vessel or introducing infection 2.

From the Research

Trigger Injection to Elbow Epicondyle

• The effectiveness of trigger injections for lateral epicondylitis has been studied, with results showing that glucocorticoid (GC) injections can provide short-term pain relief 3.
• A study comparing 5 and 10 mg triamcinolone local injection for treatment of lateral epicondylitis found that both doses had similar efficacy and adverse effects 4.
• Diagnostic and therapeutic injection of the elbow region, including medial and lateral epicondylitis, can be an effective treatment option 5.
• Local steroid injection has been shown to be effective in treating tennis elbow, with better results when combined with topical and oral NSAIDs 6.
• The use of corticosteroid injections in joints and musculoskeletal soft tissue has been guidelines by the American Society of Regional Anesthesia and Pain Medicine, with recommendations on effective doses and potential adverse events 7.

Types of Injections

• Platelet-rich plasma (PRP) injections have been studied as a treatment option for lateral epicondylitis, but results have been mixed 3.
• Glucocorticoid (GC) injections have been shown to be effective in providing short-term pain relief for lateral epicondylitis 3, 4.
• Triamcinolone injections have been studied as a treatment option for lateral epicondylitis, with doses ranging from 5 to 40 mg 4, 6, 7.

Potential Adverse Events

• Adverse events related to corticosteroid injections include increased blood glucose, adrenal suppression, detrimental effect on cartilage lining the joint, reduction of bone mineral density, and postoperative joint infection 7.
• PRP injections have been found to be more painful than GC and saline injections 3.
• The use of corticosteroid injections can have potential adverse events, and recommended effective doses are lower than those currently used by clinicians 7.