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Medial Epicondylitis

- 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.

The efficacy of an injection of steroids for medial epicondylitis. A prospective study of 60 elbows.

Resection and repair for medial tennis elbow. A prospective analysis.