- Discussion:
- may begin as a microtear between the pronator teres and the FCR;
- often associated w/ ulnar neuritis (see
cubital tunnel);
- Exam:
- tenderness over the origin of the
forearm flexors;
- resisted pronation and/or flexion will elicit pain in most patients;
- grip strength is usually be impaired;
- w/ concomitatnt
cubital tunnel may find;
- tenderness over the
ulnar nerve;
- positive Tinel sign;
- decrease 2 point in litte finger;
- intrinsic atrophy;
- Radiographs:
- may see calcification at the flexor origin;
- Non Operative Treatment:
- expected to be successful in the majority of patients;
- counterforce brace (circumferential orthosis)
- steroids: as noted by Stahl and Kaufman, a steroid injection (methylprednisolone 40 mg) afforded some relief
a 6 weeks, but no apparent relief at 3 months;
- Operative Treatment:
- debridement w/ release of flexor pronator origin or reattachement of muscle origin;
- often only a partial debridement of the FCR and the prontator teres origin will be required;
- partial cortical shaving of the medial epicondyle helps promote healing;
- w/ concomitant ulnar neuritis,
isolated release of the cubital tunnel may
not suffice, since the nerve will continue to lie in a bed of inflammation;
- in stead, an
anterior transposition will generally be necessary;
- since the flexor pronator origin will be partially released and debrided as a part of the procedure,
consider performing a sub-muscular transposition;
Operative treatment of medial epicondylitis. Influence of concomitant ulnar neuropathy at the elbow.
G.T. Gabel MD, and B.F. Morrey.
JBJS Vol 77-A No. 7, Jul 1995.
The efficacy of an injection of steroids for medial epicondylitis.
A prospective study of 60 elbows.
S. Stahl and T. Kaufman.
JBJS. Vol 79-A. No 11. Nov 1997. p 1648.
Resection and repair for medial tennis elbow.
A prospective analysis.
CO
Ollivierre et al.
Am. J. Sports Medicine. Vol 23. p 214-221. 1995.
