Can steroid injections be administered to the humeroulnar (humeroradial and humeroulnar) joint?

Steroid Injections to the Humeroulnar Joint

Yes, corticosteroid injections can be safely and effectively administered to the humeroulnar joint for pain management and inflammation reduction. 1

Anatomical Considerations

• The humeroulnar joint is part of the elbow complex and forms the articulation between the trochlea of the humerus and the trochlear notch of the ulna
• This joint primarily allows for flexion and extension of the elbow
• The joint is accessible for injection using proper anatomical landmarks or imaging guidance

Technique and Administration

• Proper technique is essential:
  • Strict aseptic technique is mandatory to prevent infection 2
  • Patient positioning: seated with the elbow flexed at 90 degrees on a supportive surface
  • Approach: typically posterior or lateral approach to access the joint space
  • Ultrasound guidance is optional but beneficial for ensuring accurate placement 1
  • After withdrawal, inject without delay to prevent settling of the suspension in the syringe 2

Medication Selection and Dosage

• Recommended medication:
  • Triamcinolone acetonide: 5-15 mg for elbow joints 2
  • Can be mixed with local anesthetic (e.g., lidocaine) for immediate pain relief 1
  • For smaller joints like the elbow, doses up to 10 mg are typically sufficient 2
  • Higher doses (up to 40 mg) may be used for larger joints but are generally not needed for the elbow 2, 3

Efficacy and Outcomes

• Intra-articular corticosteroid injections provide significant short-term pain relief, typically lasting 4-8 weeks 1
• They reduce inflammation and improve mobility, allowing for better participation in rehabilitation 1
• Most effective for inflammatory conditions affecting the joint, such as rheumatoid arthritis or osteoarthritis 4
• The American College of Rheumatology conditionally recommends intra-articular glucocorticoid injections for hand OA, which can be extrapolated to other upper extremity joints 4

Precautions and Limitations

• Limit injections to 3-4 per year with a minimum interval of 6-8 weeks between injections 1
• Monitor for potential complications:
  • Transient increased blood glucose in diabetic patients for up to two weeks 5
  • Potential for subcutaneous fat atrophy if injection is not properly placed 2
  • Theoretical risk of accelerated cartilage loss with multiple repeated injections 4
  • Low risk of infection (rare but serious complication) 1

Post-Injection Care

• Avoid overuse of the injected joint for 24 hours following the procedure 1
• Patient may experience transient post-injection pain flare 1
• Continue physical therapy during and after injection therapy to maximize benefits 1
• NSAIDs and analgesics may be used concurrently for additional pain management 1

Alternative Injectable Options

• If corticosteroid injections provide insufficient relief, viscosupplementation (hyaluronic acid) may be considered as an alternative, though evidence for its use specifically in the elbow is limited 1, 6

By following these guidelines, corticosteroid injections to the humeroulnar joint can be a safe and effective treatment option for managing pain and inflammation in this joint.