Ultrasound Guided Intra-Articular Radiocapitellar Joint (Lateral Approach) Injection

MATERIALS 25-gauge, 1.5-inch needle 3-ml syringe with mixture of 0.5 ml of corticosteroid and 1–2 ml of local anesthetic High-frequency linear array transducer Sterile ultrasound probe cover Sterile ultrasound gel Sterile gloves Chlorhexidine or other skin antiseptic 4 × 4 gauze Band-Aid PATIENT POSITIONING The patient is placed seated or supine with the affected elbow on a pillow. Before the procedure, the forearm is passively pronated and the elbow is flexed 20–40 degrees. The physician should position themselves lateral to the elbow with the ultrasound screen in direct view. PROBE POSITIONING The transducer is placed in the transverse plane over the radiocapitellar joint and in long axis with the radius. NEEDLE TECHNIQUE The needle is introduced using an out-of-plane approach and walk-down technique from posterior to anterior. The final target of the needle should be at the posterior aspect of the radiocapitellar joint. PEARLS AND PITFALLS Care should be taken to identify the radial nerve at this level which, depending upon individual patient anatomy, may include the radial nerve proper or its distal branches including the posterior interosseous and superficial radial nerves. Ultrasound-Guided Injection Video Series: Intra-Articular Radiocapitellar Joint, https://links.lww.com/PHM/C599