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Cortisone injection for carpal tunnel
We perform diagnostic ultrasound and ultrasound guided steroid injections for a variety of elbow problems. These include:
Tennis Elbow (common extensor origin pain)
Tennis elbow refers to inflammation of the tendons attaching to the outer aspect of the elbow. It has other names, including “lateral epicondylitis”, referring to inflammation of the lateral epicondyle (the bony attachment of the tendon at the outer aspect of the elbow), and “common extensor tendinitis” refers to inflammation of the tendon attachment. It is not necessarily seen in Tennis players and can be seen in other sports like weight lifting and manual workers. It usually presents with gradual or sudden onset pain at the outer aspect of the elbow, exacerbated by activity. The pain can extend into the forearm and the hand, leading to weakness. To find out more, please see our article about Tennis elbow.
Golfer's Elbow (common flexor origin pain)
Golfers elbow refers to inflammation of the tendons attaching to the inner aspect of the elbow. It is also referred to as “medial epicondylitis”, meaning inflammation of the medial epicondyle (the bony attachment of the tendon at the inner aspect of the elbow), and “common flexor tendinitis”, meaning inflammation of the tendon attachment. It is not only seen in Golf players but also in other sports that involve repetitive movements like weight lifting and manual workers. It usually results in pain at the inner aspect of the elbow, which can be exacerbated by activity. To find out more, please read our article about Golfer's elbow.
Ultrasound guided injections for Tennis & Golfer’s elbow
Ultrasound examination is very useful in establishing the diagnosis and assessing the severity of the inflammation or presence of tendon tear. The treatment for both conditions usually starts with a supervised physiotherapy program, including strengthening exercises. Ultrasound-guided injection therapy can be considered if the above measures are failing. Steroid injection for tennis elbow is an option. However, evidence suggests that they result in only short-term pain relief only, with no significant difference in the outcome in the long term. Steroids are injected adjacent to the tendon to reduce the inflammation. They should never be injected into the tendon as they can possibly weaken it.
Ultrasound guided elbow PRP injections
Therefore, ultrasound guided tendon fenestration or platelets-rich plasma (PRP) injections are preferable for treating Golfers and tennis elbow. In tendon fenestration/tenotomy, a small needle is used to fenestrate the inflamed tendon multiple times under ultrasound guidance. This is thought to cause micro-injury and result in the release of certain factors to help in tendon healing. In ultrasound guided PRP injection, a blood sample is taken from the patient's vein and put in a special centrifuge machine to separate its different components. The layer on the top is called “the plasma” and contains platelets and other useful growth factors. This is injected into the tendon under ultrasound guidance to help stimulate healing. Please see our article about PRP injections for more details.
A bursa is a thin-walled fluid sac usually seen between the tendons and bones and acts as a cushion to reduce the stress in certain areas “Bursitis” refers to inflammation of this fluid sac. The Olecranon is the bone at the tip of your elbow joint. Olecranon bursitis happens when the olecranon bursa becomes enlarged, thickened and inflamed. It can cause significant pain and swelling at the back of the elbow. It can happen secondary to direct trauma to the area or as a result of repetitive friction. It is also common in some inflammatory conditions like gout. The symptoms of olecranon bursitis include pain and swelling at the back of the elbow. The swelling is usually soft, compressible and can change in size. To find out more, please read our article about Olecranon bursitis.
If conservative management is not helping, especially if the bursa is sizeable, then an ultrasound-guided aspiration and steroid injection in wrist can be considered to reduce the swelling and provide quick pain relief. Performing the procedure under ultrasound guidance will increase accuracy and reduce discomfort during the procedure.
Distal biceps tendon pain
The biceps is the big muscle at the front of the upper arm and consists of two parts (the short and the long heads). It has two important functions: to bend/flex the arm (like when doing biceps curls in the gym) and to rotate the elbow and wrist inward (like when using a screwdriver). The distal biceps tendon is part of the tendon at the level of the elbow joint that attaches to the radial tuberosity (bony prominence at the upper forearm). Distal biceps tendon problems usually result in pain at the front of the elbow. It is commonly seen when there is overload upon the tendon, like in those who lift heavy weights during biceps curls in the gym and manual workers. Distal bicep tendon pain can be secondary to tendon inflammation (tendinitis) or tear. Distal biceps tendon problems usually result in dull pain below the elbow level. The pain can increase when doing certain exercises like biceps curls and bar pull-ups and may result in forearm weakness. To find out more, please read our article Distal biceps tendon pain. Bicipital radial bursitis is another condition that can be seen separately or in association with distal biceps tendinitis. It refers to inflammation of the bursa (thin sac of fluid) between the distal biceps tendon and its attachment to the bone (the radial tuberosity).
Most cases of distal biceps tendonitis will settle with conservative measures like exercise modification and anti-inflammatory tablets. In difficult cases, Steroid injections in ancle can be considered, especially if there is an inflamed bicipital radial bursa. We prefer to perform ultrasound-guided tendon fenestration or platelets-rich plasma (PRP) injection. In tendon fenestration/tenotomy, a small needle is used to fenestrate the inflamed tendon multiple times under ultrasound guidance. This is thought to result in micro injury and the release of factors that help tendon healing. In ultrasound-guided PRP injection, a blood sample is taken from the patient's vein and put in a special centrifuge machine to separate its components. The "plasma layer” contains platelets and other useful growth factors. This can be obtained and injected into the tendon under ultrasound guidance to help stimulate healing. Please see PRP injections for more details.
Cubital tunnel syndrome
The cubital tunnel is located at the inner aspect of the elbow joint. It provides passage to a certain nerve (called the ulnar nerve). Various causes can result in pressure upon the ulnar nerve in this area resulting in pain and numbness at the inner aspect of the forearm and to the little and ring fingers. Examples include ganglion cysts (small fluid sacs usually come off the joint) and osteophytes (small bony spurs resulting from wear and tear). To find out more, please read our article about cubital tunnel syndrome.
Another cause for ulnar nerve irritation at the cubital tunnel is when the ulnar nerve is unstable and dislocates outside the cubital tunnel on forearm movements. This condition is referred to as “ulnar nerve subluxation/dislocation”. The patient may feel a snapping sensation at the inside of the elbow when the nerve dislocates, associated with pain and numbness at the inner aspect of the forearm and the little and ring fingers.
Ultrasound examination is very useful for assessing the ulnar nerve for any thickening or changes that indicate nerve inflammation or irritation. It can also assess for any local cause for pressure upon the nerve and perform a dynamic assessment of the ulnar nerve at the level of the cubital tunnel to assess for ulnar nerve dislocation.
Snapping ulnar nerve. The ulnar nerve is thickened and seen snapping outside the cubital tunnel on dynamic ultrasound assessment.
Frequently asked questions about ultrasound-guided elbow injections
What are the different ultrasound-guided treatments options available for Elbow pain?
The ultrasound-guided treatment options to help in the management of elbow conditions include:
Ultrasound-guided platelet-rich plasma (PRP) injections.
Ultrasound-guided tendon fenestration.
What is an elbow cortisone injection?
Corticosteroid (cortisone) is a potent anti-inflammatory medicine routinely used to manage inflammatory conditions (like bursitis, arthritis, and tendinosis). A cortisone injection for carpal tunnel will reduce the inflammation in the injected area (like the elbow joint or the bicipitoradial bursa) and allow you to manage the condition, usually by undergoing a physiotherapy program. It can also be injected around inflamed tendons in Tennis and Golfer's elbows.
What is ultrasound-guided fenestration?
Ultrasound-guided tendon fenestration is one treatment option for managing Golfers and tennis elbow. In tendon fenestration/tenotomy, a small needle is used to fenestrate the inflamed tendon multiple times under ultrasound guidance. This aims to induce micro-injuries within the tendon, which is thought to release certain factors to help tendon healing. Performing this under ultrasound guidance is essential to ensure accuracy.
What is ultrasound-guided PRP injections for elbow pain?
PRP injections are increasingly used to manage tendonitis around the elbow joint (mainly Tennis and Golfers elbow). In an ultrasound-guided PRP injection, a blood sample is taken from the patient's vein and put in a special centrifuge machine to separate its components. The layer on the top is called “the plasma” and contains platelets and other useful growth factors. This is injected into the tendon under ultrasound guidance to help stimulate healing.
Do I need an injection for my elbow pain?
The management of most elbow conditions starts with physiotherapy treatment and progressive rehabilitation. The duration of this depends on the condition. If the response from the above is slow or not satisfactory, then an ultrasound-guided elbow treatment option may be considered. Injection therapy can be very useful in reducing pain and improving function, allowing for more effective rehabilitation. We always advise performing elbow injections under ultrasound guidance by an experienced doctor to ensure accurate delivery of the medicine to the targeted area.
why should elbow injections be done under ultrasound guidance?
This is our routine practice as there is plenty of evidence supporting the use of ultrasound guidance when performing musculoskeletal injections. Doing elbow injections under ultrasound/imaging guidance allows for direct visualisation of the needle to ensure accurate placement into the area of pain/inflammation (like a bursa, an arthritic joint or an inflamed tendon sheath). Ultrasound guidance results in more accurate, less painful and faster procedures, with better outcomes compared to doing these injections without guidance. Ultrasound guidance ensures to avoid any sensitive structures (like nerves and vessels) during the procedure.
What are the commonly used steroid medicines in elbow injections?
The commonly used types of steroid injections for musculoskeletal conditions are triamcinolone (Kenalog) and methylprednisolone (Depo-medrone). These preparations are long-acting steroid injections that normally take a few days to start working.
How long will the effect of an elbow cortisone injection last?
Current evidence suggests that cortisone injection wrist can improve pain and function for up to 3 months, but in some cases, it can last longer. The injections usually also contain a local anesthetic that provides immediate pain relief lasting a few hours.
How soon will a steroid injection start to work?
A steroid injection usually takes a few days (1-3) before you notice the effect, although sometimes the pain relief can start on the same day. More commonly, the injected area will feel sore for the first few days. This is referred to as (steroid flare) and can be seen after a steroid injection Carpel Tunnel. Other treatments like PRP and tendon fenestration can take a few weeks (2-5 weeks) before noticing any results.
What is the benefit of ultrasound scans in managing patients with elbow pain?
Imaging, particularly ultrasound plays a vital role in establishing the correct diagnosis, assessing the severity of the condition and deciding about the best treatment options. Ultrasound is useful to assess the soft tissues around the elbow (ligaments and tendons), including the common flexor and extensor origins, distal biceps and triceps tendons. It is also very useful to assess for any fluid build-up around the elbow joint (like joint effusion and olecranon bursa). It is also extremely useful to guide injection therapy around the elbow joint.
The Musculoskeletal Ultrasound & Injections clinic
169 Richmond Road
Kingston upon Thames
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