Medial Epicondylitis / Golfers Elbow

Incidence

 

10% of elbow tendonitis

 

Aetiology

 

Overuse injury

- poor swing in golf

- poor throwing technique

- overuse of topspin in tennis

- occupational (repetitive hammering / screwing)

 

Some patients also have lateral epicondylitis

 

Examination

 

Tenderness CFO

 

Stimulate pain

- flexion of WJ with fingers resisting

- resisted pronation 

- resisted ulna deviation

 

May have ulna nerve symptoms

 

Xray

 

Rule out OA / OCD elbow

 

DDx

 

MCL insufficiency

- must differentiate from MCL instability

- if release CFO in setting of MCL laxity will have frank instability post-op

 

Management

 

Non-Operative Management

 

As per tennis elbow

 

Operative Management

 

Surgical Release

 

Medial incision

- identify and protect ulna nerve

- release of CFO

- protection of MCL

- debridement of scar and bony prominence

- drill holes into epicondyle

- reattachment of CFO

- + / - Ulnar nerve decompression

 

Post op

- splint

- no resisted wrist flexion / pronation 6 - 8 weeks

- no sport for 4 - 6 months

 

Results

 

Segal 1992

- small series 

- 11 of 16 good results with operative release

 

Vangness JBJS Br 1991

- 35 operative cases

- felt the underlying pathology was a tear in the CFO

- incomplete healing

- treatment as described above

- 34/35 good or excellent results

- 1 patient could not return to sport