Radiohumeral joint injection is used to diagnose and treat the painful and swollen elbow due to rheumatoid arthritis or nonspecific inflammatory arthritides.
After informed consent is obtained, the patient is placed in the sitting position with the elbow flexed to 90 degrees. The lateral epicondyle and posterior olecranon are palpated. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 1½-in. (4-cm), 21- to 23-gauge needle is inserted into the groove just above and lateral to the olecranon process, just below the lateral humeral epicondyle, and posterior to the head of the radius. The needle is gently manipulated into the joint. Aspiration is attempted until the needle has entered the synovial space. If there is an effusion of the joint, the aspiration is completed. After negative aspiration or if the aspirated fluid is noninflammatory (clear and viscous), the joint is injected with a 5-mL mixture of 10 mg of triamcinolone acetonide (or equivalent) and local anesthetic (Fig. 67-41).
FIGURE 67-41. Radiohumeral joint injection. Approach for radiohumeral joint aspiration and injection.
The connective tissue surrounding the elbow joint should be evaluated as a possible source of pain before injection of the radiohumeral joint.
Corticosteroids should not be injected if there is any suspicion that the bursa is infected. If the fluid appears infected, it should be sent for culture and sensitivity and the patient treated appropriately for the infection.