Abstract
For lateral epicondylitis, an alternative to traditional corticosteroid injection at the ECRB origin is intraarticular injection. Our hypothesis is that intraarticular injection effectively reaches the pathologic ECRB origin/lateral capsule and avoids nearby structures such as the posterior interosseous nerve (PIN). Eight pairs (n=16) of fresh frozen cadaver specimens were divided into two groups: extraarticular (deep to the ECRB) and intraarticular. A 5cc solution of Omnipaque and methylene blue was administered by the senior author. Radiographs were taken both before and 1 minute after the injections. The elbows were dissected to determine capsular integrity and to localize methylene blue infiltration. Statistical analysis was performed using the students t test. Of extraarticular injections, 38% were found to have diffused into the joint, and 100% infiltrated the ECRB origin. In 50% of the specimens with an extraarticular injection, dye was found surrounding the PIN. Of intraarticular injections, 88% diffused into the ECRB origin, and 100% were in the joint. The present study defines the ability of the most commonly used injection technique (extraarticular subtendinous) to reach the ECRB tendon and lateral capsule, and may support an alternative intraarticular technique for its ease, ability to reach pathologic tissue, and reduced risk of complications. We found that (1) both injections techniques successfully localized to the ECRB origin; (2) intraarticular injections were more successful at reaching both components of pathology (ECRB and capsule); and (3) extraarticular injections are associated with localization around the PIN.
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