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Medial Epicondylitis M77.00 726.31

elbow ligaments image

synonyms: Golfers elbow, medial epicondylitis, common flexor tendon tear, common flexor tenosynovitis, handball player's elbow

Medial Epicondylitis ICD-10

Medial Epicondylitis ICD-9

  • 726.31 (medial epicondylitis)

Medial Epicondylitis Etiology / Epidemiology / Natural History

  • Pain in the medial aspect of the elbow due to fibrillary degeneration of collagen, angiofibroblastic hyperplasia , vascular granulation tissue, tendinous necrosis and secondary inflammation of the flexor-pronator muscle mass.
  • golf, rowing, baseball pitching, javelin, tennis, bricklaying, hammering, typing, textile production
  • 4th to 5thdecade
  • male=female
  • 7-20 times less common than lateral epicondylitis

Medial Epicondylitis Anatomy

  • medial epicondyle=flexor pronator muscle mass origin
  • from prox to distal = pronator teres, FCR, palmaris longus, FDS, FCU
  • pronator teres and FCR, most commonly involved, both arise form medial supracondylar ridge
  • throwing – peak angular velocity and valgus stress occur primarily during acceleration phase(0 forward velocity to ball release)

Medial Epicondylitis Clinical Evaluation

  • Pain along the medial elbow.
  • Pain exacerbated by resisted forearm pronation and wrist flexion.
  • Tenderness over the origin of the flexor-pronator muscle mass.
  • Normal elbow/wrist ROM
  • Evaluate for Cubital Tunnel Syndrome(holding elbow maximally flexed with wrist extended for 3 minutes produces pain and numbness, Tinel's at elbow)
  • Evaluate for Posterolateral Rotatory Instability
  • Note

Medial Epicondylitis Xray / Diagnositc Tests

Medial Epicondylitis Classification / Treatment

  • Nonsurgical treatment = avoid offending activity, NSAIDs, physical therapy, counterforce bracing,
  • Physical therapy =wrist flexor and forearm pronator stretching and progressive isometric exercises advancing to eccentric/concentric exercises as tolerated
  • Corticosteriod injection: benefits remain controversial. Double-blind studies have indicated no long term benefit. Risks / complications include: fat atrophy, depigmentation of skin, disruption of muscle origin, post-injection flare, facial flushing, iatrogenic infection. (Stahl S, JBJS 1997;79Am:1648)
  • Surgical Treatment Indications: failure of nonoperative management for a minimum of 6 to 12 months

Medial Epicondylitis Surgical Technique

  • (Vangsness CT Jr, JBJS Br 1991;73:409-411)
  • supine, arm board, tourniquet, pre-op antibiotic
  • 8cm longitudinal incision centered over medial epicondyle
  • Common flexor origin reflected
  • Ensure medial collateral ligament is preserved and ulnar nerve is protected.
  • Pathologic tissue on undersurface of the flexor pronator mass in excised.
  • Medial epicondyle is debrided/drilled to a bleeding bone bed.
  • Common flexor pronator origin reattached with suture
  • Closure
  • Posterior splint

Medial Epicondylitis Associated Injuries / Differential Diagnosis

Medial Epicondylitis Complications

  • continued pain
  • infection
  • ulnar nerve palsy
  • stiffness
  • instability

Medial Epicondylitis Follow-up Care

  • Splint removed at 7-10 days. Gentle elbow ROM started. Hand wrist ROM encouraged.
  • Resisted wrist flexion/pronation started at 6 weeks
  • Return to activity at 4 months post-op
  • Excellent/Good results obtained in 97% of pts. 86% had no limitations(Vangsness CT Jr, JBJS Br 1991;73:409-411)

Medial Epicondylitis Review References


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