Lateral Epicondylitis / “Tennis Elbow”ICD-9 code: 726.32 “lateral epicondylitis”ICD-10 codes:M77.11 “lateral epicondylitis, appropriate elbow”M77.12 “lateral epicondylitis, left elbow”

CPT code: 20551

Materials Needed

Pen – clicking typeGloves – non-sterileAlcohol swabs (or iodine)Band-aidTuberculin needle/syringe OR 1-ml syringe through 25-gauge 1.5″ needle (depending on human body habitus)Injectate:0.5-ml of 6mg/ml that Celestone OR 0.5-ml of 40mg/ml Depo-Medrol or Kenalog0.5-ml that 1% lidocaine

Technique / Procedure Steps

Always begin with educated consent native the patient, and also then a time-out come verify exactly patient and injection site.Mark the injection website with the pen tip in bespeak to leaving an impression in the skin — Point of maximal tenderness (usually simply distal come lateral epicondyle).Clean the skin extensively with as numerous alcohol swabs as needed (usually just one is needed).

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Patient position: seated (typically), yet can execute lying supine v elbow flexed 90-degrees too.With the tuberculin needle/syringe, go into perpendicular to the skin, and also go down to the periosteum, then earlier off a mm or two.Aspirate to make certain you’re no in any kind of vessel.After an unfavorable aspiration, inject the full components of the syringe.Note: May additionally want to just inject 1/4 that the injectate, then reposition the needle in 3 other locations roughly that painful area to get much more spread of the steroid.Withdraw the needle and apply band-aid.

Tips

Finding the injection site Point of maximal tenderness (POMT) just distal to lateral epicondyle.Can execute Cozen’s check (resisted wrist extension) to discover the POMT.Numbing the skin Since I usage a small tuberculin needle, many patients have no trouble with the injection and also don’t need any extra lidocaine skin wheal or freeze spray.I tell lock numbing the skin with lidocaine will probably hurt an ext than the actual injection.Procedure for a “pain free” injectionFill a 27G 1/2″ tuberculin syringe v 0.5-ml of 1% lidocaine.Use ethyl chloride spray come “numb” the skin over the injection site; then quickly produce the skin wheal the lidocaine.Insert the reminder of the needle just listed below the surface of the skin, nearly at a parallel angle. Then inject about 0.5-ml to produce the skin wheal.

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Corticosteroid choiceIf patient has actually a background of post-injection flare (somewhat much more common through injections here), use Celestone, compounded betamethasone salt phosphate, or Decadron.After the injection Have the patience flex and also extend the elbow a few times if you litter away supplies.Then, re-palpate the POMT and also have lock repeat the Cozen’s test so they deserve to see the immediate results that the lidocaine.Explain to the patient the the lidocaine will wear turn off in one hour or so, and that they will certainly be ago to their normal pain until the steroids begin kicking in (anywhere from 1-7 days).May additionally ask the patient to not perform much activity with that arm for 12-24 hours.