Anconeus Epitrochlearis as a Source of Medial Elbow Pain in Baseball Pitchers

Abstract

Medial elbow pain is reported in 18% to 69% of baseball players aged of 9 and 19 years. This is due to the large valgus stresses focused on the medial side of the elbow during overhead activities. In overhead throwers and pitchers, pain can be attributed to valgus extension overload with resultant posteromedial impingement, overuse of the flexor-pronator musculature resulting in medial epicondylitis, or occasional muscle tears or ruptures. The anconeus epitrochlearis is a known cause of cubital tunnel syndrome and has been postulated as a source of medial elbow pain in overhead athletes. This article describes the cases of 3 right-handed baseball pitchers with persistent right-sided medial elbow pain during throwing despite a prolonged period of rest, physical therapy, and nonsteroidal anti-inflammatory drugs. Two patients had symptoms of cubital tunnel syndrome as diagnosed by electromyogram and nerve conduction studies and the presence of the anconeus epitrochlearis muscle per magnetic resonance imaging. All patients underwent isolated release of the anconeus muscle without ulnar nerve transposition and returned to their previous levels of activity. The diagnosis and treatment of pitchers who present with medial-sided elbow pain can be complex. The differential should include an enlarged or inflamed anconeus epitrochlearis muscle as a possible cause. Conservative management should be the first modality. However, surgical excision with isolated release of the muscle can be successful in returning patients with persistent pain despite a trial of conservative management to their previous levels of function.

Hypotheses for ongoing evolution of muscles of the upper extremity

“…As over 70% of the human population does not even have this muscle(27), one can see that the muscle must not be necessary in humans and may be indicative of a late evolutionary process. Indeed, presence of an AE may not only be unnecessary, but may cause problems such as ulnar neuropathy, cubital tunnel syndrome and elbow pain(28, 29). It is therefore important for clinicians to be aware of the potential presence of the AE [Figure 2], as it may potentially be a contributing factor to patients presenting with elbow pain or neuropathy.…”

Treatment of Medial Epicondylar Tendinopathy in Athletes

“…MET usually presents as pain of insidious onset along the medial elbow, worse when participating in the offending sport. 20 Physical examination in MET patients typically reveals point tenderness at the medial epicondyle of the elbow and pain with resisted forearm pronation (Fig. Questioning the patient about exposure to fluoroquinolone antibiotics should also be done for all patients with elbow pain as there is a demonstrated association with tendinopathy.…”

Clinical Application of Anomalous Muscles for Tendon Transfer in the Upper Limb: A Systematic Review of the Literature

“…Most of the studies were either about anatomical findings in cadavers or those found incidentally in the operating field [2][3][4][5][6][7][8][9][10][11]. Although the majority of anomalous muscles are asymptomatic, they may occasionally produce persistent pain, unexplained mass, or compression neuropathy necessitating surgical excision [7,8,[11][12][13][14][15][16][17]. Despite several anatomical descriptions, the actual reports of the clinical application of such anomalous muscles are sparse.…”