title: Injection of tennis elbow: Hit and miss? A cadaveric study of injection accuracy.
abstract: OBJECTIVE
  Different injection therapies are used in the treatment of lateral epicondylitis (LE). Usually, the extensor carpi radialis brevis (ECRB) tendon is affected. Therefore, an injection should be aimed at the origin of this tendon. This study demonstrates the accuracy of manual injections in the treatment of LE.
  
  
  METHODS
  Ten surgeons have injected a cadaver elbow with acrylic paint, using the same injection technique (i.e. number of perforations, amount of injected fluid) that they in daily practice would use in the treatment of LE. After the injection, an arthroscopy and dissection of the elbow were performed. The injection technique and localization of acrylic paint were reported.
  
  
  RESULTS
  Only a third of the injections were (partially) localized in the ECRB tendon; 60 % were localized intra-articular.
  
  
  CONCLUSIONS
  Injections carried out manually for the treatment of LE are not accurate, resulting in the majority being localized intra-articular. For future research to the effect of injection therapy in the treatment of LE, it is important that injections should be performed in a reproducible and standardized way.
authors.affiliation: Department of Orthopaedic Surgery, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands. reneekeijsers@gmail.com.
authors.forename: Renée
authors.initials: R
authors.lastname: Keijsers
authors.affiliation: Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.
authors.forename: Michel P J
authors.initials: MPJ
authors.lastname: van den Bekerom
authors.affiliation: Foundation for Orthopaedic Research, Care and Education, Amphia Hospital, Breda, The Netherlands.
authors.forename: Koen L M
authors.initials: KLM
authors.lastname: Koenraadt
authors.affiliation: Department of Anatomy, UMC, Utrecht, The Netherlands.
authors.forename: Ronald L A W
authors.initials: RLAW
authors.lastname: Bleys
authors.affiliation: Department of Orthopaedic Surgery, AMC, Amsterdam, The Netherlands.
authors.forename: C Niek
authors.initials: CN
authors.lastname: van Dijk
authors.affiliation: Department of Orthopaedic Surgery, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: Eygendaal
mesh_terms: D001182:Arthroscopy; D002102:Cadaver; D004210:Dissection; D006801:Humans; D007267:Injections / Q000379:methods*; D013710:Tendons; D013716:Tennis Elbow / Q000628:therapy*
keywords: Cadaveric study; Elbow; Injection accuracy; Injection technique; Injection therapy; Lateral epicondylitis