This post reviews corticosteroid injections of the elbow, wrist and hand.
This post reviews corticosteroid injections of the elbow, wrist and hand. This article will cover some of the randomized trials and reviews on corticosteroid injections for some of the most common issues that present to a sports medicine practice including lateral and medial epicondylitis, de Quervain’s tenosynovitis, trigger finger, carpal tunnel syndrome. Lateral epicondylitis , or tennis elbow, is the most common disease of the elbow affecting 1-3 percent of the population 1 .
It is typically due to repetitive strain to the extensor tendon, notably extensor carpi radialis brevis (ECRB), or by forced extension or direct trauma to the lateral epicondyle. The term epicondylitis was proposed in 1936 and was challenged in the 1970s. Over 600 cases of chronic epicondylar pain showed dense population of fibroblasts, disorganized and immature collagen, and an absence of inflammatory cells 33 .
These findings are considered characteristic of a degenerative process, which was called ‘‘angiofibroblastic hyperplasia,’’ now commonly known as tendinosis. More recent histology has been similar and it has been suggested to alter the name to terms such as epicondylosis or epicondylalgia and refer to this more as a tendinosis, as opposed to a true tendonitis 33 . However, the term epicondylitis and tendonitis remain the most common terminology.
Conservative treatment typically includes rest, avoidance of aggravating activities, modification of behavior, physical therapy and analgesic medications. There are variable practice patterns in the use of corticosteroid injections for lateral epicondylitis among practices and some physicians will offer an injection on the first visit. The literature for CSI does not provide conclusive evidence over which corticosteroid, the exact volume, the exact area of injection (at the point of maximum tenderness or at anatomical position) or the injection method.
One study showed no difference between hydrocortisone 25 mg to be equivalent to triamcinolone 10 mg. Many practices use 20-40 mg of triamcinolone today. A couple more recent studies showing limited long term benefit and high recurrence have brought this practice into question 2 , 3 .
If you are experiencing symptoms that may be related to evidence behind injections on the elbow, wrist and hand, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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