Lateral Epicondylitis Injection

About this injection

Lateral epicondylitis — commonly called tennis elbow — is a painful condition caused by overuse and degeneration of the common extensor tendon at its attachment to the lateral epicondyle of the humerus. Despite the name, it affects far more non-tennis players than tennis players, and is one of the most common musculoskeletal conditions seen in general practice.

Corticosteroid injection into the area of maximum tenderness at the lateral epicondyle provides rapid and effective pain relief, allowing patients to return to normal activities and begin the rehabilitation that prevents recurrence.

Dr Hasham performs the injection using anatomical landmark technique, targeting the point of maximum tenderness at the lateral epicondyle. The procedure takes under 20 minutes and is well tolerated.

Conditions treated

• ✓Lateral epicondylitis (tennis elbow) — the primary indication
• ✓Common extensor tendinopathy — degeneration of extensor carpi radialis brevis
• ✓Persistent elbow pain not responding to rest and physiotherapy
• ✓Occupational overuse injury — repetitive gripping, twisting, or lifting

Symptoms

• —Pain and tenderness directly over the lateral epicondyle (outside of the elbow)
• —Pain on gripping, lifting, or carrying — especially with the elbow extended
• —Weakness of grip strength
• —Pain on resisted wrist extension and middle finger extension
• —Difficulty with everyday activities — pouring a kettle, shaking hands, opening jars
• —Pain radiating down the forearm

Assessment & diagnosis

Diagnosis is clinical. Cozen's test (resisted wrist extension with elbow extended) and Mill's test reproduce the pain. Maximum tenderness is localised directly over the lateral epicondyle. Grip strength is often reduced on the affected side. Imaging is not routinely required.

Treatment options

What happens on the day

1. Clinical assessment and confirmation of diagnosis — Cozen's and Mill's test
2. Point of maximum tenderness marked on the lateral epicondyle
3. Patient seated with elbow flexed to 90°, forearm pronated
4. Skin cleaned with antiseptic
5. Corticosteroid and local anaesthetic prepared
6. Needle inserted perpendicular to the skin at the point of maximum tenderness
7. Peppering technique — multiple small deposits across the tendon insertion
8. Needle withdrawn, pressure applied
9. Aftercare instructions provided

Injection technique

The needle is directed to the point of maximum tenderness on the lateral epicondyle. A 'peppering' technique is used — the needle is partially withdrawn and redirected multiple times to distribute the corticosteroid across the tendon insertion. Methylprednisolone 20–40mg in 1–2ml local anaesthetic is used. Care is taken to inject at the tendon-bone interface rather than into the tendon substance.

Risks & side effects

• —Post-injection flare — common in the first 24–48 hours; more pronounced than with joint injections
• —Skin depigmentation and subcutaneous fat atrophy at the injection site — more common with superficial injections
• —Temporary worsening of symptoms — settle within 72 hours
• —Tendon weakening with repeated injections — avoid more than 2–3 injections at the same site
• —Paradoxically, short-term injection benefit does not improve long-term outcomes without physiotherapy

Aftercare

• ✓Rest the arm completely for 48 hours after injection
• ✓Expect a post-injection flare — ice and paracetamol help
• ✓Avoid gripping, lifting, and repetitive forearm activity for 2 weeks
• ✓Begin eccentric wrist extension exercises 2 weeks after injection
• ✓Consider a tennis elbow brace for return to activity
• ✓Physiotherapy is essential to prevent recurrence

Frequently asked questions