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Evidence Grade A: For the relief of pain during the first six weeks of symptom onset.
Obtain informed consent.
Gather the appropriate materials.
First, draw up 2-3cc of 1 or 2% lidocaine into a 5cc syringe.
Then draw up the steroid into the same syringe in order for them to intermix. You may use this list of four commonly used steroids as a reference.
Have the patient sit on the exam table, with the affected arm flexed to approximately 45 degrees.
Their hand should be supported comfortably with the palm facing downwards.
You may also choose to have the patient rest their arm on a bedside table.
In this image: The patient's arm is flexed at a 45-degree angle.
Palpate the lateral epicondyle, which is the bony prominence on the lateral side of the distal humerus.
This is where the wrist extensors and supinators originate. The patient should be tender in this area.
Now, palpate just slightly inferior and medial to the lateral epicondyle. This is usually where the patient is most tender.
In this image: The physician palpates the lateral epicondyle to detect tenderness.
Insert a 25-gauge, 1-inch needle perpendicular to the skin, and advance 2-3mm. If you hit bone, withdraw the needle 1-2mm and begin to inject the medication. It is often helpful to inject in several directions within the same plane.
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