Recommended Dosing for Elbow Bursitis Injection
For elbow bursitis injection, use 1-2 mL of 1% lidocaine combined with 20-40 mg of triamcinolone or methylprednisolone. 1, 2
Local Anesthetic Component
- The recommended local anesthetic for elbow bursitis injection is 1-2 mL of 1% lidocaine 3, 4
- Maximum safe dose of lidocaine with epinephrine is 7 mg/kg and without epinephrine is 4.5 mg/kg in adults 3
- For a typical elbow bursitis injection, the amount of lidocaine used (10-20 mg) is well below the maximum safe dose 3
- Lidocaine provides immediate pain relief during and shortly after the injection procedure 3
- Buffering lidocaine with bicarbonate, warming it before injection, and injecting slowly with a small-gauge needle can minimize injection pain 3
Corticosteroid Component
- Triamcinolone or methylprednisolone are the most commonly used corticosteroids for joint and bursa injections (used by 50-56% and 25-29% of sports medicine physicians, respectively) 1
- The recommended dose range for elbow bursitis is 20-40 mg of corticosteroid 1, 2
- Lower doses (20 mg) of triamcinolone have been shown to be as effective as higher doses (40 mg) for other bursal injections, suggesting a similar approach may be appropriate for elbow bursitis 2
- For small joints and bursae, doses at the lower end of the range are typically sufficient 5
- The FDA recommends 2-4 mg of dexamethasone for bursal injections, which is equivalent to approximately 10-20 mg of triamcinolone 5
Total Volume and Technique
- The total injection volume for elbow bursitis should typically be 3-5 mL 1
- Most sports medicine physicians use 5-7 mL total injectate volume for large joints and bursae (45-54% of physicians), with smaller bursae receiving 3-4 mL 1
- Aspirate before injecting to ensure the needle is not in a blood vessel 3
- Use sterile technique to minimize risk of infection 2
Potential Adverse Effects and Precautions
- Monitor for potential adverse effects including increased blood glucose, adrenal suppression, and post-injection infection 2
- Local anesthetic agents are cardiac depressants and may cause central nervous system excitation or depression at high doses 3
- Avoid using high doses of corticosteroids (>40 mg of triamcinolone or methylprednisolone) as over one-third of physicians report using these higher doses despite evidence that lower doses are equally effective 1, 2
- Consider ultrasound guidance to increase accuracy and reduce procedural pain, especially in difficult cases 2
Expected Outcomes
- Corticosteroid injections typically provide short-term pain relief lasting from a few weeks to a few months 2
- A single injection is sufficient for most patients (29.9% of patients in one study), though some may require repeated injections (4-6 weeks apart) 6
- Local corticosteroid injection followed by physical therapy is effective in approximately 49% of patients with similar conditions 6