There can be many reasons for your elbow pain, many of which respond well to injection therapy. Please click on the links below to find out more about each condition:

Commonly asked questions:

When should you consider an elbow injection?

Most patients with elbow pain do not need an injection. Many people respond very well to conservative treatment, including physiotherapy. However, if you have been suffering from elbow pain which is not recovering with physiotherapy and a rehabilitation programme, then an injection may be helpful.

An ultrasound guided injection should be considered if you have a clear diagnosis for your pain and it is not improving or is getting worse. At Complete, our team of highly trained clinicians are fully qualified physiotherapists and musculoskeletal sonographers. A full assessment is carried out before an elbow injection is performed to make sure we have the right diagnosis and ensure an injection is an appropriate treatment. The assessment involves a combination of clinical testing and a diagnostic ultrasound scan. There is no extra charge for the ultrasound scan as we need to identify the target tissue before carrying out an injection. An ultrasound scan can diagnose most elbow complaints, including tennis and golfer’s elbow, the two most common issues we see at the elbow.

If you have already seen a health care professional and you have been told what is causing your pain, an ultrasound scan is still carried out prior to an injection, to plan the injection and confirm the target tissue.

Injection therapy is an effective, evidence-based treatment to reduce pain and inflammation, allowing you to address the underlying problem.

If you are suffering from one or more of the following, an injection may be of benefit for you:

  • Significant pain that has been present for over 6 weeks, or has been getting worse.
  • Pain that is waking you at night or is affecting your ability to get to sleep.
  • Pain that is affecting your ability to use the elbow, wrist and hand, especially with repetitive tasks involving gripping.
  • Pain that is reducing your ability to work effectively, complete activities of daily living, play sport, or undertake hobbies.

If you would like to talk to one of our clinical experts or would like to book an appointment, please contact Complete Injections on 020 7482 3875 or email injections@complete-physio.co.uk.

What injections are available to treat elbow pain?

There are four types of injection for patients suffering with elbow pain. The correct one really depends on your diagnosis and your current situation. Your clinician will discuss the most effective treatment programme with you following your assessment. We will also provide a series of exercises to complete after your injection has been carried out.
The injection options available for elbow pain are listed below:

Steroid injections
Platelet rich plasma injections
Hyaluronic acid injections
Tendon fenestration

Should all elbow injections be ultrasound guided?

Yes. Ultrasound guided injections ensure a more accurate, safer, and less painful injection compared to landmark guided injections. An ultrasound machine is used to visualise the intended target in ‘real time’. This allows a needle to be monitored throughout the injection procedure, ensuring the medication is delivered safely and directly to the desired area.
Ultrasound guided injections have been reported to be more accurate, more effective, cause less local trauma, and result in less post-injection complications than landmark guided injections. All injections undertaken at Complete are ultrasound guided.

Are elbow injections painful?

Most patients tolerate injections very well, reporting them to be no worse than a vaccination or blood test. Individual experience of pain varies considerably, with some people finding injections more comfortable than others.

An ultrasound guided injection can help to reduce the risk of experiencing a painful injection due to a few key points:

  • Being able to visualise the target and the approach of the needle means that any delicate structures can be avoided, resulting in less local tissue trauma.
  • Ultrasound guided injections allow the use of thinner needles which pass through the tissue layers with ease, causing minimal trauma.
  • Ultrasound imaging allows for the most effective route to be selected prior to the injection being carried out, resulting in a quick and safe injection.

Furthermore, all injections undertaken at Complete are accompanied by a fast acting local anaesthetic which helps to make the injection procedure and the following few hours as comfortable as possible.

How long do the effects of an elbow injection last?

The effects of an injection can vary from one person to another. Some patients experience many months or even years of pain relief. Many patients experience a complete resolution of their symptoms after a single injection. The pain relief the injection provides will depend on your specific diagnosis and the severity of your condition. The length of time you have had the symptoms can also influence the response to the injection.

Injections can provide much needed pain relief and will allow a patient to engage in a period of rehabilitation with a physiotherapist to address any underlying causes. All injections are ultimately designed to reduce pain and inflammation, resulting in improved movement and function. It is crucial that the underlying cause of your pain is addressed if maximum benefits are to be felt.

How many elbow injections can I have?

Most patients achieve lasting pain relief after a single injection combined with rehabilitation. There are some conditions that may require further injection therapy as part of a continued management plan.

Situations where more than one injection may be required include:

  • Osteoarthritis – an arthritic joint is a progressive degenerative condition which is susceptible to intermittent flares. It is a more chronic condition and the pain is likely to return at some point following an injection. Injection therapy plays an important role in managing the pain and can be of great benefit during an acute flare up.
  • Multiple conditions – it is possible to suffer from two conditions at the same time, such as tennis elbow and golfer’s elbow. Managing more complex situations might require more than one injection.
  • PRP injections often require more than one injection to maximise the pain relief achieved.

The Arthritis Research Council (ARC) reports that a maximum of three steroid injections in one area or joint can be carried out over a one-year period. At Complete, the need for three injections in one year is relatively uncommon and usually indicates that a more effective management program is required to control symptoms and increase function. To achieve maximum benefit after an injection and to reduce the need for further injections, it is important to treat the underlying cause of your symptoms.

Do injections just ’mask’ the pain?

In a word, no. A corticosteroid injection is a potent anti-inflammatory, with the aim of reducing pain and inflammation in the area. The rationale behind an injection is to control your symptoms whilst you rehabilitate your condition. For more information read here.

Will my elbow hurt after an injection?

Approximately 25% of people experience a short period of increased pain, lasting for a few days, after an injection. This is completely normal and if it happens you should not worry. Taking some over-the-counter pain medication and applying an ice pack over the injection site (10 minutes, a few times a day) is usually enough to relieve the symptoms.
It is advisable to have a short period of rest after an injection to allow the medication to take effect and to limit the chance of experiencing a pain flare.

Furthermore, some structures such as tendons require a little more protection during the first 10 to 14 days after an injection. It can be important to rest for the first two weeks to allow the tendon to recover. Your clinician will explain to you what to do and what not to do.

To know more about post-injection rest periods please follow this link.

What elbow conditions can be treated successfully with an ultrasound guided injection?

Tennis elbow

Tennis elbow is the most common cause of elbow pain seen at Complete. Tennis elbow is characterised by pain located over the outside of the elbow. It is associated with repetitive use of the forearm muscles responsible for extending the wrist and gripping, e.g. imagine ‘revving’ up a motor bike. Activities that require excessive gripping are particularly related to developing tennis elbow, and even simple activities such as gripping a door handle or lifting a kettle can become painful. Activities susceptible to tennis elbow include racquet sports, manual jobs such as building or carpentry, and weightlifting.
Signs and symptoms of tennis elbow include:
  • Pain located over the outside of the elbow joint. Tenderness is often experienced when pressing the bone on the outside of the elbow or in the muscles and tendons adjacent to the bone.
  • Pain is increased with lifting, gripping and twisting motions of the wrist, forearm and elbow.
  • Agonising pain if you accidently knock the outside of the elbow against a hard surface such as a door frame.

Tennis elbow is notoriously difficult to treat and is often resistant to conservative treatments. Steroid injections can help reduce pain in the short to mid-term however symptoms often return. Other effective injection therapy options for tennis elbow include fenestration and platelet rich plasma (PRP) injections. It is essential that after an injection for tennis elbow you undertake a course of physiotherapy to address the underlying cause of your symptoms.

At your appointment your clinician will explain the best options for you. If you would like to discuss these options before booking in, please do not hesitate to call 020 7482 3875 or email injections@complete-physio.co.uk and one of our expert clinicians will get back to you.

Golfer’s Elbow

Golfer’s elbow is a very painful condition which causes pain and tenderness specifically over the inside of the elbow. The flexor muscles of the forearm attach to the ‘bony point’ on the inside of the elbow. This region is susceptible to pain and irritation after prolonged periods of repetitive overuse, in particular tasks requiring excessive gripping. Like tennis elbow racquet sports, golf, weight lifting and manual jobs are associated with golfer’s elbow, and once present it can be a challenging condition to resolve.

Signs and symptoms of golfer’s elbow include:

  • Pain located over the inside of the elbow joint. Tenderness is often experienced when pressing the bone on the inside of the elbow or in the muscles and tendons adjacent to the bone.
  • Pain which increases with lifting, gripping and twisting motions of the wrist, forearm and elbow.
  • Significant pain when accidently knocking the inside of the elbow against a hard surface such as a table.

If a golfer’s elbow does not respond well to conservative treatment then an injection may be helpful. Injection options for golfer’s elbow include steroid, fenestration, or platelet rich plasma (PRP) injections.

Olecranon Bursitis

An olecranon bursitis can be a painful condition which causes a significant ‘golf ball like’ swelling over the tip or back of the elbow. In some patients it can become swollen but not painful.

The general consensus is that an injection should be avoided for an olecranon bursitis as a majority of them resolve spontaneously. It is important to be aware the risk of infection following an injection for an olecranon bursitis is higher than in other regions. An infection requires immediate medical attention.

The development of an olecranon bursitis is often associated with prolonged periods of leaning or weight bearing through the elbow such as when studying for an exam or working many hours at a desk. In some cases an olecranon bursitis can occur due to an infection after leaning on a splinter or thorn. If an infection is suspected then it is important to attend A&E. An infected olecranon bursitis is often red, hot, and swollen (as well as painful) and requires medical assistance, normally in the form of a course of antibiotics.

Most cases of olecranon bursitis are not infected and will often resolve themselves over a few weeks with adequate rest. If pain and swelling remain persistent and an infection has been ruled out then, an aspiration (draining) followed by a steroid injection may be of benefit.

Signs and symptoms associated with an olecranon bursitis are:

  • Pain over the tip of the elbow.
  • Swelling over the tip of the elbow (this can be a very large swelling).
  • Redness, heat, and significant pain. If this is the case then you must see your G.P. or go to A&E immediately as these symptoms are signs of possible infection.

Distal biceps pain

The distal biceps tendon attaches to the radius bone of the forearm just past the elbow joint. Pain is commonly felt over the front of the elbow in weightlifters and people with manual jobs. It is strongly associated with repetitive heavy loading of the biceps tendon and is mostly seen in men aged between 20 and 40 years old. Pain can start gradually without a traumatic event or after an accident (such as catching a sudden heavy weight). Pain from the distal biceps tendon can be mistaken for tennis elbow.

Most patients suffering from distal biceps pain respond well to a period of physiotherapy and a rehabilitation programme but if conservative treatment does not resolve your symptoms then an injection could be of benefit.

Signs and symptoms of distal biceps pain include:

  • Pain specifically located over the front of the elbow joint, near the elbow crease.
  • Pain made worse with resisted elbow flexion, such as during bicep curling.
  • A feeling of weakness in the arm.

If your distal biceps tendon does not improve with time and treatment, then an injection may be helpful. Injection options for distal biceps tendon include steroid, fenestration or platelet rich plasma (PRP) injections.

Cubital tunnel syndrome

The cubital tunnel is a bony groove located at the inner elbow. Over the top of the groove there is a ligament which stabilises and protects the ulnar nerve which passes through this tunnel. The ulnar nerve is susceptible to irritation within the cubital tunnel and in some cases can become unstable resulting in the nerve clicking as it flicks over the bone of the inner elbow during movement. If you have ever bumped your “funny bone” then you have experienced a short-lived irritation of the ulnar nerve at the cubital tunnel.

Signs and symptoms of cubital tunnel syndrome include:

  • Pain over the inside of the elbow.
  • Pins and needles over the inside of the elbow and down towards the 4th and 5th fingers.
  • Weakness may be present, affecting the 4th and 5th fingers.
  • Weakness during gripping tasks.
  • Clumsiness in the wrist and hand.

Treating cubital tunnel syndrome can be challenging as symptoms are often associated with repetitive manual work, hobbies such as weight lifting, or due to hypermobility syndromes. If symptoms do not settle with activity modification and a course of physiotherapy, then a steroid injection to calm the ulnar nerve down may be helpful.

At Complete we provide a ‘one-stop clinic’ for elbow problems. This includes a clinical assessment, a diagnostic ultrasound scan and, if deemed appropriate, an ultrasound guided injection, all in the one appointment. This reduces the requirement for unnecessary multiple appointments.

If you would like to book an appointment to see one of our clinical experts or would like further information, please contact 020 7482 3875 or email injections@complete-physio.co.uk.

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