Radiocapitellar Joint Injection

Elbow
Equipment & Medications

Equipment

14 MHz Linear Probe 25g 1.5″ Needle 5 cc Syringe (lidocaine) 3 cc Syringe (steroid mix) Procedure Tray

Medications

Lidocaine 1% — 5 cc Kenalog 40 mg/cc — 1 cc Ropivacaine 0.5% — 1 cc
Procedure Steps
1

Standard pre-procedure workup: consent, indications, contraindications, allergies, and baseline pain level.

2

Position patient seated or supine with the elbow flexed to approximately 90° and the forearm pronated, resting on the patient's lap or a pillow.

3

Place the linear probe over the lateral elbow in the long axis of the radius (coronal plane). Identify the radiocapitellar joint — the radial head articulating with the capitellum of the humerus.

Radiocapitellar joint long axis
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4

Assess for joint effusion or synovitis in the posterior radiocapitellar recess.

Posterior radiocapitellar recess
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5

Mark the needle entry site and ideal probe position on the skin.

6

Prep with betadine or chlorhexidine × 3.

7

Place sterile drape and sterile probe cover.

8

Under ultrasound guidance, create a skin wheal with 1% lidocaine using the 25g needle. Advance into the subcutaneous tissues.

Needle approach
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9

Advance needle under ultrasound guidance into the radiocapitellar joint space. The needle tip should be positioned between the radial head and the capitellum.

Needle in joint
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Injectate flow
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10

Test-inject with 1% lidocaine. If there is no resistance and you see joint distention, disconnect the syringe and exchange for the steroid/ropivacaine mixture. Inject slowly.

11

Remove needle, clean skin with alcohol, and place bandage.

12

Reassess pain level and provide patient with a pain log.

References

  1. Lin JS, Gimarc DC, Adler RS, et al. Ultrasound-guided musculoskeletal injections. Semin Musculoskelet Radiol. 2021;25(6):769–784.
  2. Lapegue F, André A, Lafourcade F, et al. Ultrasound of lateral epicondylitis. Semin Musculoskelet Radiol. 2024;28:683–693.