Medial Epicondylitis

Abstract

Medial epicondylitis, often referred to as "golfer's elbow," is a common pathology. Flexor-pronator tendon degeneration occurs with repetitive forced wrist extension and forearm supination during activities involving wrist flexion and forearm pronation. A staged process of pathologic change in the tendon can result in structural breakdown and irreparable fibrosis or calcification. Patients typically report persistent medial-sided elbow pain that is exacerbated by daily activities. Athletes may be particularly symptomatic during the late cocking or early acceleration phases of the throwing motion. Nonsurgical supportive care includes activity modification, NSAIDs, and corticosteroid injections. Once the acute symptomology is alleviated, focus is turned to flexor-pronator mass rehabilitation and injury prevention. Surgical treatment via open techniques is typically reserved for patients with persistent symptoms.

Medial elbow pain

“…Many surgical options have been described and they include some form of debridement of the origin of the flexor-pronator mass. 17 As in lateral epicondylitis, the medial epicondyle can be stimulated with perforations to promote healing and the muscle tears may be repaired back to their origin with the use of an anchor. 12 , 18 Associated procedures to the ulnar nerve include decompression, with anterior transposition in cases of instability of the nerve after decompression ( Table 2 ).…”

“…Most of the reports focus on open techniques, and although the use of elbow arthroscopy for debridement has been described in a cadaver study, clinical studies are lacking. 17 , 19 - 21 Potential dangers with this technique include damage to the MCL and the ulnar nerve. 21 Post-operatively, the arm is placed in a well-padded splint for one week and there is a transition to the use of a sling with gentle ROM activities.…”

Extracorporeal Shockwave Therapy Treatment in Upper Limb Diseases: A Systematic Review

“…Subacromial impingement syndrome (SAIS) is a pathological state of the rotator cuff tendons [5], resulting from mechanical impingement causing 50%-70% of shoulder pain cases [6]. MEP, or "golfer's elbow", is the result of common flexor tendon (CFT) microtrauma and degeneration, and might affect <1% of the general population and as many as 3.8% to 8.2% of patients in occupational settings, and typically occurs from the fourth decade of life [7]. Lateral epicondylitis (LEP) is a common chronic inflammatory degeneration of the wrist extensor tendons at their insertion to the lateral epicondyle of the humerus, affecting 1%-3% of the general population, especially between the ages of 30 and 70, without gender predisposition [8].…”

Elbow Common Flexor Tendon Repair Technique

“…Medial epicondylitis, also commonly referred to as “golfer's elbow,” is typically seen in patients in the fourth to sixth decade of life. The condition equally affects men and women and occurs more commonly in certain occupational settings, and recent reports have shown an increasing incidence in the general population 1, 2, 3, 4. The common flexor tendon is the convergence of 5 muscles: pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, and flexor carpi ulnaris 4 .…”

“…The condition equally affects men and women and occurs more commonly in certain occupational settings, and recent reports have shown an increasing incidence in the general population 1, 2, 3, 4. The common flexor tendon is the convergence of 5 muscles: pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, and flexor carpi ulnaris 4 . This common tendon is about 2.5 cm in length, attaches to the humeral medial epicondyle just proximal to the anterior bundle of the ulnar collateral ligament (UCL), and provides dynamic stability to the elbow 5, 6, 7.…”