An effective approach to diagnosis and surgical repair of refractory medial epicondylitis
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UMass Chan Affiliations
School of MedicineDocument Type
Journal ArticlePublication Date
2015-08-01Keywords
Medial epicondylitisgolfer's elbow
flexor-pronator tear
surgical repair
tendinosis
sports injury
Musculoskeletal Diseases
Orthopedics
Sports Medicine
Surgery
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BACKGROUND: Medial epicondylitis of the elbow, an overuse injury characterized by angiofibroblastic tendinosis of the common flexor-pronator origin, generally responds to nonoperative treatment. Refractory cases may require surgical debridement and repair. This study discusses physical examination and imaging findings and an updated surgical technique used in patients with recalcitrant medial epicondylitis. METHODS: The surgical records of 60 patients with refractory medial epicondylitis were reviewed. All received a course of nonoperative care. After 3 to 6 months of failed therapy, imaging was obtained, and surgical intervention was offered when indicated. This open procedure consisted of thorough debridement with repair and restoration of the flexor-pronator origin, using a suture anchor. Accelerated rehabilitation, emphasizing early motion, was used. One-year follow-ups were obtained. The Mayo Elbow Performance Score was calculated preoperatively and postoperatively. RESULTS: Pronation weakness at 90 degrees was a critical physical examination finding. Preoperative magnetic resonance images demonstrated pathologic partial tearing at the flexor-pronator origin. Ulnar neuritis was addressed in 20%. Postoperatively, the Mayo Elbow Performance Score significantly increased (preoperatively, 58 +/- 7.7; postoperatively, 88 +/- 7.8; P = 5.6E-34), and pain significantly decreased (preoperatively, 2.2 +/- 0.3; postoperatively, 0.6 +/- 0.5; P = 3.8E-33). There was one retear in a patient noncompliant with the postoperative protocol. He responded positively to reoperation. CONCLUSION: Identification of weakness on pronation is a reliable physical examination finding for determining clinically significant pathologic changes in patients with medial epicondylitis. Debridement with restoration of the flexor-pronator origin is an efficacious procedure. In this large series of patients, surgical repair with aggressive rehabilitation was shown to be reliable and safe in restoring function and relieving pain in recalcitrant cases of medial epicondylitis.Source
J Shoulder Elbow Surg. 2015 Aug;24(8):1172-7. doi: 10.1016/j.jse.2015.03.017. Link to article on publisher's siteDOI
10.1016/j.jse.2015.03.017Permanent Link to this Item
http://hdl.handle.net/20.500.14038/39829PubMed ID
26189803Related Resources
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Copyright 2015 The Authors. Published by Elsevier Inc. on behalf of Journal of Shoulder and Elbow Surgery Board of Trustees. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
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http://creativecommons.org/licenses/by-nc-nd/4.0/ae974a485f413a2113503eed53cd6c53
10.1016/j.jse.2015.03.017
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Except where otherwise noted, this item's license is described as <p>Copyright 2015 The Authors. Published by Elsevier Inc. on behalf of Journal of Shoulder and Elbow Surgery Board of Trustees. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).</p>