The Elbow

Biceps Tenoperiosteal lesion

Infiltration

Material: A thin needle, 3 cm long and a 2 cc syringe filled with 20 mg of triamcinolone

Position: The patient lies prone on the couch. The uper arm is passively held in
external rotation by his side and the elbow is stretched.
The elbow is now passively put in full pronation.
Attention!!! : the upperarm is held in full lateral rotation!!

Palpation
Palpate the head of the radius and the joint line.
Palpate the posterior edge of the ulna.
Radial tuberosity and insertion of the biceps tendon can now be felt 2-3 cm distally from the joint and just laterally to the ulna.

Technique:
The needle is inserted at the chosen point and pushed vertically downwards through a tendinous structure until it hits the bone (radial tuberosity).
The infiltration is now performed by a series of small droplets according to the usual infiltration technique: insertions and partly withdrawals to disperse the product at different levels and depths throughout the affected structure.
Sufficient tissue resistance during the procedure proves the correct position of the needle.

Follow up:

Moderate after pain during 24 -48 hours may be experienced
The patient should avoid flexion and supination movements for a week.
A second injection is given if the clinical tests are not completely negative after two weeks.
In most cases, one or two infiltrations will suffice for a complete cure.