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Techniques in Hand & Upper Extremity Surgery:
Technique

Medial Epicondylitis

Ciccotti, Michael G. MD; Ramani, Mohnish N. MD

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Abstract

Medial epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins at the medial epicondyle. Although commonly referred to as “golfer's elbow”, the condition may in fact be caused by a variety of sports and occupational activities. Accurate diagnosis requires a thorough understanding of the anatomic, epidemiologic, and pathophysiologic factors. Nonoperative treatment involves rest, ice, nonsteroidal anti-inflammatory agents, and possibly corticosteroid injection followed by guided rehabilitation and return to sport. Operative treatment is indicated for debilitating pain after exclusion of other pathologic causes that persists in spite of a well-managed nonoperative regimen spanning a minimum of 6 months. The surgical technique involves excision of the pathologic portion of the tendon, repair of the resulting defect, and reattachment of the origin of the flexor pronator muscle group to the medial epicondyle. Surgical treatment results in a high degree of subjective relief, although objective strength deficits may persist.

Epicondylitis is one of the most common elbow problems in adults. This entity was first described in an austere letter published by Henry J. Morris in Lancet in 1882. 1 From this seminal description has evolved a vast array of detailed diagnostic and therapeutic reports. Morris focused on medial epicondylitis as caused by the lawn tennis backstroke, but subsequent works have greatly expanded the authors understanding of location, etiology, pathophysiology, and therapeutic modalities of this enigmatic entity. Although much has been written about lateral epicondylitis, literature regarding medial epicondylitis has been scant in comparison. This is likely due to its lower incidence, which is reported to be between 9.8% and 20% of all epicondylitis diagnoses. 2,3,4 Medial epicondylitis, or “golfer's elbow”, refers to an overuse syndrome of the flexor pronator mass. The muscles involved include the pronator teres, flexor carpi radialis, palmaris longus, 5 and occasionally flexor carpi ulnaris and flexor digitorum superficialis. 6 Epicondylitis, as the name implies, once was thought to be related solely to local inflammation, but histologic analysis has demonstrated tendon degeneration and an incomplete reparative process. Because of this, some have preferred the term tendinosis when describing epicondylitis.

© 2003 Lippincott Williams & Wilkins, Inc.

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