When is an elbow injection considered?

When to Consider Elbow Injections

Elbow injections should be considered for patients with persistent pain from inflammatory conditions, particularly when conservative treatments have failed to provide adequate relief. 1

Specific Indications for Elbow Injections

Inflammatory Arthritis

• Intra-articular glucocorticoid injections are indicated for patients with inflammatory arthritis affecting the elbow joint, such as rheumatoid arthritis 1
• Local injections should be considered as adjunctive therapy in patients with persistent inflammatory joint pain despite systemic treatment 1

Lateral and Medial Epicondylitis

• Corticosteroid injections are an accepted treatment option for lateral epicondylitis ("tennis elbow") and medial epicondylitis ("golfer's elbow") when conservative measures have failed 1
• These conditions are among the most common causes of elbow pain, affecting 1-3% of the population 1
• Consider injection when pain persists despite rest, activity modification, analgesics, and physical therapy 1

Olecranon Bursitis

• Aspiration and injection of the olecranon bursa is indicated when the bursa is inflamed and causing significant pain or functional limitation 2

Osteoarthritis

• Intra-articular corticosteroid injections can be considered for symptomatic elbow osteoarthritis 2, 3
• Patients with elbow arthritis may experience pain relief for an average of 12.5 weeks following injection 3

Patient Selection Criteria

• Patients with active disease as defined by swollen joints and/or moderate disease activity by composite measures 1
• Patients with monoarthritis or oligoarthritis of the elbow 1
• Patients who have failed conservative management including:
  • Rest and activity modification
  • Oral analgesics (paracetamol/acetaminophen, NSAIDs)
  • Physical therapy and exercise programs 1

Timing Considerations

• For elective joint replacement surgery, injections should be performed at least 3 months prior to surgery to minimize infection risk 1
• After joint replacement, injections should only be performed following consultation with the surgical team 1
• Limit injections to no more than 3-4 per year in the same joint (though this is based on expert opinion rather than strong evidence) 1

Special Considerations

Diabetic Patients

• Diabetic patients, especially those with suboptimal control, should be informed about the risk of transient increased blood glucose levels following intra-articular glucocorticoid injection 1
• These patients should be advised to monitor glucose levels particularly from the first to third day after injection 1

Patients on Anticoagulants

• Elbow injections are not contraindicated in people with clotting/bleeding disorders or those taking antithrombotic medications, unless bleeding risk is high 1

Injection Technique Considerations

• Aseptic technique should always be used when performing injections 1, 4
• Local anesthetic may be offered to reduce procedural discomfort 1
• Accuracy of injection placement is important; ultrasound guidance may be used to improve accuracy when available 1
• Patients should avoid overuse of the injected joint for 24 hours following injection, though complete immobilization is discouraged 1

Limitations and Cautions

• For lateral epicondylitis, evidence suggests that corticosteroid injections may provide short-term relief but do not change long-term outcomes 1, 5
• Autologous blood or platelet-rich plasma (PRP) injections for lateral elbow pain probably do not provide clinically significant improvement compared to placebo (moderate-certainty evidence) 5
• Corticosteroid solution should not be injected directly into the tendons of the elbow 4
• Repeated injections are generally not advised due to potential tissue damage 4