What steroid is recommended for lateral epicondylitis injections?

Steroid Selection for Lateral Epicondylitis Injections

Triamcinolone acetonide is the recommended corticosteroid for lateral epicondylitis injections, with dosing of 5-10 mg being effective while minimizing adverse effects.

Corticosteroid Selection and Dosing

Triamcinolone acetonide is the preferred corticosteroid for lateral epicondylitis injections based on available evidence:

• Dosage: 5-10 mg is recommended for lateral epicondylitis (tennis elbow) 1

  • 5 mg triamcinolone has shown comparable efficacy to 10 mg with potentially fewer adverse effects 2
  • FDA labeling supports using 5-15 mg for larger joints and 2.5-5 mg for smaller joints 1

• Injection technique:

  • Single injection at the point of maximum tenderness is preferred over peppered technique 3
  • Infiltrate the preparation into the area of greatest tenderness 1
  • Care should be taken to inject into the tendon sheath rather than the tendon substance to avoid tendon rupture 1

Efficacy and Considerations

Corticosteroid injections provide excellent short-term relief but have important long-term considerations:

• Short-term efficacy: Corticosteroid injections are more effective than NSAIDs in the acute phase of epicondylosis 4

  • At 6 weeks post-injection, success rates of 92% have been reported compared to 47% for physiotherapy 5

• Long-term outcomes:

  • Corticosteroids do not change long-term outcomes of pain 4
  • High recurrence rates after initial improvement 5
  • By 52 weeks, success rates drop to 69% for injections compared to 91% for physiotherapy 5

Injection Guidance

• Ultrasound guidance shows no statistically significant improvement in outcomes compared to blind injection technique 6
• Proper technique is more important than imaging guidance
• Strict aseptic technique is mandatory 1

Common Pitfalls to Avoid

1. Tendon rupture risk: Avoid injecting directly into the tendon substance

   • Inject into the area of greatest tenderness, not the tendon itself 1

2. Skin atrophy: Avoid injecting into subcutaneous tissues

   • Reported in approximately 7.6% of patients receiving corticosteroid injections 7

3. Dosing errors: Using excessive doses increases risk of adverse effects

   • 5 mg triamcinolone is as effective as 10 mg with potentially fewer side effects 2

4. Recurrence management: Be aware of high recurrence rates

   • Consider alternative treatments for recurrent cases (physiotherapy, dry needling)
   • Dry needling has shown better long-term outcomes in some studies 7

5. Patient expectations: Inform patients about short-term benefits but potential long-term limitations

   • Corticosteroid injections provide excellent short-term relief but may not improve long-term outcomes 4, 5

By following these recommendations, clinicians can optimize outcomes when using corticosteroid injections for lateral epicondylitis while minimizing potential adverse effects.