Injection Placement for Palpation-Guided Intra-Articular Glucocorticoid Therapy for the Elbow

Author(s): Tomas Weitoft, Magnus Hjelm

Objectives: There are two different palpationguided injection techniques described how to enter the elbow joint when injecting intraarticular glucocorticoids – the lateral and the posterior. Both methods are used in clinical practice and based on individual experience each practicing physician decides which technique to use. The aims of the present study were to compare the accuracy of palpationguided injection placement and the clinical effects regarding pain and function between these methods.

Methods: Patients at the rheumatology department at Gävle hospital, Sweden, presenting with clinical signs of elbow synovitis were included and randomized to either lateral or posterior injection technique using 20 mg trimacinolone hexacetonide in combination with a contrast agent. Radiographs with lateral view were performed immediately after the injection and were blindly assessed by an independent radiologist. A validated questionnaire regarding elbow pain and function was answered before and one month after the injection.

Results: 24 elbows in 20 patients were randomized, to lateral (n=12) or posterior (n=12) injection technique. All lateral injections were correct and so were 67% of posterior injections. The difference was statistically significant (p<0.05). Synovial fluid aspiration was successful in 50% and 17% respectively. There were no significant differences between the treatment arms regarding pain reduction and functional improvement.

Conclusion: This study shows that the proportion of correct injection placement for the elbow is larger with lateral technique. There were no differences between the treatment arms regarding the clinical response, but a larger study is necessary to draw firm conclusions.

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