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Joint injection of the elbow is a useful diagnostic and therapeutic tool for the family physician. In this article, the injection procedures for the elbow joint, medial and lateral epicondylitis, and olecranon bursitis are reviewed. Persistent pain related to inflammatory conditions responds well to injection in the region. Indications for...

Biceps (bicipital) tendonitis is an inflammation of the long head of the biceps tendon as it passes through the bicipital groove of the anterior humerus.
* Repetitive lifting and, to a lesser extent, overhead reaching lead to inflammation, microtearing, and, if untreated, degenerative change.
* Patients with bicipital tendonitis typically report anterior...

Arthrocentesis (synovial fluid aspiration) can be performed diagnostically (for identification of the etiology of acute arthritis) or therapeutically (for pain relief, drainage of septic effusion, or injection of medications).1,2 The clinician performing the procedure should be familiar with the anatomy of the specific joint in order to avoid puncture of...

When a bursa becomes inflamed, it may be categorized as either septic or aseptic. Noninfective or aseptic bursitis is a sterile inflammation, which may occur secondary to acute trauma, overuse injury, crystal deposition (eg, gout, pseudogout), or systemic disease (eg, rheumatoid arthritis [RA], uremia, systemic lupus erythematosus).
Aseptic cases account for...

Use of cortisone injections in the treatment of muscle and joint inflammatory reactions is becoming increasingly popular. First popularized by Janet Travell, MD, muscle injections are a remarkably effective adjunct to pharmacologic and physical therapies and are safe and easy to perform. Joint injections, while technically more difficult to perform,...

Intra-articular injection of corticosteroids can be useful in patients who have failed treatment with NSAIDs. They have minimal risk of systemic side effects. Suppression of hypothalamic-pituitary-adrenal axis hasn’t been reported with intra-articular injections.
Aspiration is not performed unless there is tense effusion.
Weight bearing joints should be rested for 24 hours after...

The shoulder is the site of multiple injuries and inflammatory conditions that lend themselves to diagnostic and therapeutic injection. Joint injection should be considered after other therapeutic interventions such as nonsteroidal anti-inflammatory drugs, physical therapy, and activity-modification have been tried. Indications for glenohumeral joint injection include osteoarthritis, adhesive capsulitis, and...

Joint injection of the wrist and hand region is a useful diagnostic and therapeutic tool for the family physician. In this article, the injection procedures for carpal tunnel syndrome, de Quervain's tenosynovitis, osteoarthritis of the first carpometacarpal joint, wrist ganglion cysts, and digital flexor tenosynovitis (trigger finger) are reviewed. Indications...

Injection of the flexor tendon in the hand is most commonly performed for the treatment of stenosing tenosynovitis. Stenosing tenosynovitis, also known as trigger finger, involves a size mismatch between a thickened or stenotic first annular (A1) pulley in the hand and the flexor tendon trying to glide through the...

Epidural steroid injections (ESIs) have been endorsed by the North American Spine Society and the Agency for Healthcare Research and Quality (formerly, the Agency for Health Care Policy and Research) of the Department of Health and Human Services as an integral part of nonsurgical management of radicular pain from lumbar...

The acromioclavicular (AC) joint is a diarthrodial joint that joins the distal end of the clavicle with the acromion. It is surrounded by a joint capsule in which lies a meniscal disk. The AC ligaments, made up of the superior, inferior, anterior, and posterior ligaments, help with anteroposterior stability and...

Open joint injuries are skin and soft tissue injuries that penetrate the joint space. Like open fractures, open joint injuries require timely diagnosis, exploration, and irrigation to minimize long-term morbidity and mortality. The procedure of intra-articular injection of methylene blue is an easy and safe way to identify disruption of...

Arthrocentesis (synovial fluid aspiration) can be performed diagnostically (for identification of the etiology of acute arthritis) or therapeutically (for pain relief, drainage of septic effusion, or injection of medications).1,2 The clinician performing the procedure should be familiar with the anatomy of the specific joint in order to avoid puncture of...

Lateral epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins of the extensor carpi radialis brevis and longus tendons.
Though commonly known as tennis elbow, lateral epicondylitis may be caused by various sports and occupational activities.
Corticosteroids and other drugs often are injected in and around soft-tissue periarticular lesions to...

Medial epicondylitis of the elbow is a lesion of the common flexor tendon at the medial epicondyle.
Corticosteroids often are injected in and around soft-tissue periarticular lesions to treat regional pain syndromes.
Epicondylitis can be treated successfully in 90% of cases by local corticosteroid injection into the tender tendon origin at the...