Etiology
Golfer's elbow
Much less common than lateral epicondylitis
- 10 - 20% of epicondylitis
Overuse injury
- dominant arm
- athletes / labourers
- repetitive wrist flexion and pronation
Anatomy
Common flexor pronator origin (5 muscles)
- attaches to medial epicondyle
- Pronator teres / FCR / PL / FDS / FCU
Pathology
Degeneration / angiofibroblastic hyperplasia
Partial tears - usually within Pronator teres and FCR tendons
Clinical
Tenderness common flexor origin
Pain with resisted wrist and finger flexion / resisted pronation
Ulna nerve symptoms
- ulna neuritis present in up to 20% of patients
Exclude MCL insufficiency in athletes
- valgus stress test
- 30 degrees of flexion
- compare to the other side
MRI
Thickening of common flexor pronator tendon +/- tendon tears
Exclude
- ulna neuritis
- MCL insufficiency
Nonoperative management
Options
Most of evidence based upon treatment of lateral epicondylitis
www.boneschool.com/lateral-epicondylitis
Counterforce braces
Physiotherapy - eccentric exercises
Shock wave
Transdermal nitroglycerin patches
Dry needling
Injections - cortisone / PRP / Botox
Operative management
Options
Open medial release
Arthroscopic medial release
Ultrasound guided percutaneous tenotomy
Results
- open medial release and repair in 60 patients
- all good outcomes except one competitive athlete who returned within 3 months
Open medial release / debridement / repair
Technique
Vumedi open medial release video
Vumedi open medial release video 2
Medial incision over epicondyle
- identify and protect ulna nerve
- split extensor fascia
- detach common flexor pronator origin from medial epicondyle
- protection of MCL
- debridement of scar and bony prominence
- reattachment of CFO with anchors
- repair fascia
- + / - ulnar nerve decompression
Arthroscopic release
Technique
Arthroscopy techniques medial release PDF
Vumedi arthroscopic medial release video
Ultrasound guided percutaneous tenotomy
Youtube TenJet medial epicondylitis video