Elbow
Ultrasound-guided injection for epicondylitis
The inflamed tendon in epicondylitis is treated with precision under direct ultrasound visualisation: the needle reaches the painful area of the tendon for a targeted treatment (corticosteroid injection or, in cases with fluid, lavage of the microtears).
How it is performed
Epicondylitis is inflammation of the tendons that anchor the forearm muscles to the epicondyle (lateral, in tennis elbow, or medial, in golfer's elbow). Using ultrasound, the thickened and hypervascular tendon segment is identified, sometimes with microtears; under direct visualisation a thin needle reaches the site and a corticosteroid injection is performed, or, when fluid is present, a mechanical lavage of the microtears. Ultrasound guidance allows nerve structures to be avoided and the medication to be deposited exactly where needed. This is an ultrasound-guided procedure performed under local anaesthesia, through an access point of a few millimetres.
Who it is for
- Lateral or medial epicondylitis with persistent pain on gripping and lifting
- Lack of response to rest, brace, physiotherapy and medications
- Tendinopathy documented on ultrasound with signs of inflammatory activity
Recovery
You return home immediately. In the first 48 hours it is advisable to rest from the painful sporting or work activity and apply ice; benefit develops over the following days and physiotherapy is started once pain has decreased.
Conditions treated in this area: lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow), wrist extensor/flexor tendinopathy.
Scientific evidence
Available randomised studies compare different minimally invasive options for refractory lateral epicondylitis: ultrasound-guided dry needling showed outcomes comparable to open-release surgery in a randomised trial, avoiding surgery for most treated patients; other randomised studies evaluated adding autologous plasma to needling and compared autologous blood with corticosteroid. Ultrasound guidance allows precise treatment of the affected tendon segment, including any microtears.
References on PubMed
- Treatment of chronic lateral epicondylosis: a randomized trial comparing the efficacy of ultrasound-guided tendon dry needling and open-release surgery
Bureau NJ, Tétreault P, et al. — Eur Radiol, 2022 · PMID 35482125
- Do blood growth factors offer additional benefit in refractory lateral epicondylitis? A prospective, randomized pilot trial of dry needling as a stand-alone procedure versus dry needling and autologous conditioned plasma
Stenhouse G, Sookur P, Watson M — Skeletal Radiol, 2013 · PMID 23912197
- A randomised control trial to evaluate the efficacy of autologous blood injection versus local corticosteroid injection for treatment of lateral epicondylitis
Dojode CM — Bone Joint Res, 2012 · PMID 23610690
Published data describe average results in groups of patients and are not a prediction of an individual outcome. The indication for treatment must always be assessed during a consultation.
Risks, costs and opinions
The three questions patients ask most often before deciding, with clear answers.
What are the risks of ultrasound-guided injection for epicondylitis?
It is an outpatient procedure performed with a thin needle under local anaesthesia and continuous ultrasound guidance, which makes it possible to see the needle, the target and the structures to avoid in real time. The most common issues are transient: pain or swelling for 24-48 hours, a small bruise. Joint infection is a rare event, prevented by sterile technique. In treatments with cortisone, facial flushing or a temporary rise in blood sugar may occur in diabetic patients. Personal risks and contraindications are assessed during the consultation.
How much does the ultrasound-guided injection for epicondylitis cost?
The cost depends on the setting in which the procedure is performed: some treatments are available through the National Health Service or under agreement, others privately or through insurance. The quote is given clearly before scheduling the treatment, and includes the assessment, the procedure and the planned follow-up. During the consultation I tell you which pathway is available in your case: you do not have to decide before knowing the cost.
Does it really work? What patients and the literature say
The most frequent questions are "how long does the benefit last?" and "can I repeat it?". The answer depends on the diagnosis and the stage: some injections resolve the painful episode, others serve to open a window in which rehabilitation becomes effective. Experiences read in forums concern cases different from yours. During the consultation we review your imaging and I tell you frankly what to expect, how many sessions may be needed and when another approach is better.
Want to know if it is right for you?
At the first consultation we review your clinical history and previous imaging together.