What can be injected for an elbow joint injection?

Elbow Joint Injection Options

For elbow joint injections, corticosteroids are the primary injectate, with triamcinolone 10-20 mg being the most effective evidence-based choice, typically mixed with local anesthetic (lidocaine 1-2%). 1, 2, 3

Recommended Corticosteroid Preparations

Triamcinolone Acetonide (First-Line)

• Dose: 10 mg triamcinolone is as effective as 20 mg for elbow injections 2, 3
• The FDA-approved dosing range for smaller joints is 2.5-5 mg, and for larger joints 5-15 mg, with doses up to 40 mg used for larger areas 1
• 10 mg triamcinolone provides more rapid symptom relief than 25 mg hydrocortisone or lidocaine alone, with less need for repeat injections 2
• Triamcinolone 40 mg/mL concentration is commonly used for tennis elbow, with pain relief occurring within 1-72 hours 4

Alternative Corticosteroid Options

• Methylprednisolone appears similar in efficacy to triamcinolone for large joint injections, though specific elbow data is limited 3, 5
• Hydrocortisone 25 mg is less effective than triamcinolone 10 mg for lateral epicondylosis 2

Injection Technique Considerations

Local Anesthetic Addition

• Mixing corticosteroid with 1-2 mL of 1% or 2% lidocaine is standard practice 1, 2, 6
• Lidocaine alone provides inferior long-term results compared to corticosteroid combinations 2
• For lateral epicondylitis, infiltrate the preparation into the area of greatest tenderness over the lateral epicondyle 1

Volume and Preparation

• Total injection volume typically 2 mL (corticosteroid + lidocaine) 2, 6
• The vial must be shaken before use to ensure uniform suspension, and injected without delay after withdrawal to prevent settling 1
• Strict aseptic technique is mandatory 1

Clinical Efficacy and Expectations

Short-Term Outcomes

• Corticosteroid injections are more effective than NSAIDs in the acute phase of lateral epicondylosis 7
• 73-90% of patients achieve pain relief at 6-12 weeks when corticosteroids are combined with NSAIDs 6
• Pain relief typically occurs within 1-3 days, though approximately 50% of patients experience post-injection pain flare before improvement 2, 4

Long-Term Limitations

• Corticosteroid injections do not change long-term outcomes of elbow pain beyond 6 months 7
• Relapse is common, with recurrence rates of approximately 18% at 6 months 4
• Many patients still have residual pain at 24 weeks regardless of treatment 2

Important Adverse Events and Precautions

Common Side Effects

• Post-injection pain flare occurs in approximately 50% of steroid-treated patients and can be severe and persistent 2, 3
• Injection-site soreness affects approximately 13% of patients 8
• Skin atrophy is more frequent with triamcinolone than other preparations 2

Systemic Effects

• Increased blood glucose levels 3
• Adrenal suppression with repeated injections 3
• Facial flushing and sweating (2.3% incidence) 8

Clinical Pitfalls to Avoid

• Avoid injecting into the tendon substance itself—ensure injection is into the tendon sheath or peritendinous area to prevent tissue atrophy 1
• Do not use agglomerated product (white precipitate in vial)—discard if clumping occurs 1
• Higher doses (20 mg vs 10 mg triamcinolone) do not provide superior outcomes and increase systemic adverse event risk 2, 3
• Corticosteroids should be viewed as short-term symptom management, not definitive treatment, as they do not alter long-term outcomes 7