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Patient in prone position for medial epicondylitis repair to allow for elbow arthroscopy. Arm is extended over an arm board with a bump under the elbow to elevate and stabilize the operative field (left). Incision begins 2 cm proximal to the medial epicondyle and extends 3 to 4 cm distally (right). DE, distal extension; PE, proximal extension.
Source publication
Background
Various techniques have been described for surgical treatment of recalcitrant medial epicondylitis (ME). No single technique has yet to be proven the most effective.
Purpose
To evaluate the clinical outcomes of a double-row repair for ME.
Study Design
Case series; Level of evidence, 4.
Methods
A retrospective review was performed on 3...
Context in source publication
Context 1
... shoulder was then internally rotated, allowing us to place the hand on a simple arm board, with the elbow flexed to 70 exposing the medial side of the elbow for the incision. As shown in Figure 2, an incision was started 2 cm proximal to the medial elbow in line with the intermuscular septum and then continued distally just anterior to the epicondyle and down the forearm for an additional 3 to 4 cm. ...
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A 49-year old woman was evaluated for developing bilateral acute medial elbow pain, numbness, and tingling sensation in the fourth and fifth fingers after receiving radial extracorporeal shock wave therapy (rESWT) for bilateral medial epicondylitis. Neurologic examination revealed the presence of Tinel’s sign, paresthesia and impaired two-point dis...
Citations
... The most typical ultrasonography results in the common flexor tendon include localised, hypoechoic alterations, ligament sheath thickening, full-or partialthickness rips, Doppler-based neovascularization and cortical abnormalities where the medial epicondyle is [5,19]. Injuries to the ulnar nerve and ulnar instability of the collateral ligament as a result of valgus stress can both be evaluated by dynamic imaging investigations using ultrasound [21]. Generally speaking, people rarely experience medial elbow pain. ...
Golfer's elbow, also known as medial epicondylitis, is a common disease. When doing activities that include wrist flexion and forearm pronation, repetitive forced wrist extension and forearm supination can lead to flexor-pronator tendon degeneration. An ongoing pathologic process in the tendon can lead to structural failure, irreversible fibrosis, or calcification. The most common complaint from patients is chronic, medial-sided elbow pain that gets worse with everyday activity. During the late cocking or early acceleration stages of the throwing action, athletes may have symptoms that are particularly severe. Injections of corticosteroids, activity modification, and NSAIDs are all examples of nonsurgical supportive therapy. After the acute symptoms have subsided, attention is directed toward injury prevention and flexor-pronator mass rehabilitation. Patients with severe symptoms are often the only ones who receive open surgical procedures. Hence the study aimed to summarize and explain the evidences regarding surgical management of medial epicondylitis (golfer’s elbow).
... [6][7][8] Doublerow repairs have also been described for subscapularis tears, shoulder capsulolabral repair, medial epicondylitis, and hip abductor repair with varying results. [9][10][11][12] Conceptually, double-row repairs increase construct stiffness, better re-create broad anatomic footprints, and provide compression of tendon to bone via suture bridges. Despite this, there is a paucity of data describing significant clinical benefits to double-row repairs. ...
Quadriceps tendon ruptures compromise the knee extensor mechanism and cause an inability to ambulate and significant functional limitations. Therefore, the vast majority of quadriceps tendon ruptures are indicated for operative intervention to restore patient mobility and function. Although these injuries were traditionally repaired using a transosseous repair technique, recent literature has shown that suture anchor repair may offer biomechanical advantages. Additionally, research in other areas of orthopaedics has found that a double-row suture anchor construct can offer additional biomechanical strength to tendinous repair. This technical note describes a safe and effective quadriceps tendon repair using a double-row suture anchor construct.
... The surgical procedure, described in detail by Wu et al, 30 began with a small T-type incision with open debridement of the damaged tendon. Repair was then performed using a single 1.9-mm, double-loaded, all-suture suture anchor (Suturefix Ultra; Smith & Nephew). ...
Background
Medial epicondylitis (ME) is characterized as an overuse injury resulting in pathological alterations of the common flexor tendon at the elbow. Platelet-rich plasma (PRP) has recently become of interest in the treatment of musculoskeletal conditions as an alternative to operative management.
Purpose
To compare the outcomes of recalcitrant type 1 ME after treatment with either PRP or surgery.
Study Design
Cohort study; Level of evidence, 3.
Methods
To compare the 2 methods of treatment, we performed a retrospective review of 33 patients diagnosed with type 1 ME from 2006 to 2016 with a minimum clinical follow-up of 1 year who had failed an initial nonoperative treatment program of injections, medication, topical creams, and/or physical therapy. Overall, 15 patients were treated with a series of 2 leukocyte-rich PRP injections, and 18 patients were treated with surgery. Outcome measures included time to pain-free status, time to full range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the Oxford Elbow Score (OES). Each patient had at least 1-year follow-up. They were then contacted by telephone to determine final scores at a minimum 2-year follow-up. Unsuccessful outcomes were determined by the Nirschl grading system and failure to reach pain-free status, achieve baseline ROM, or return to previous activity.
Results
The mean final follow-up was 3.9 years. A statistically significant improvement was noted in both time to full ROM (42.3 days for PRP vs 96.1 days for surgery; P < .01) and time to pain-free status (56.2 days for PRP vs 108.0 days for surgery; P < .01). Successful outcomes were observed in 80% of patients treated with PRP and 94% of those treated operatively ( P = .37). No significant difference was found in return-to-activity rates, overall successful outcomes, MEPS scores, or OES scores.
Conclusion
In this case series, the use of PRP showed clinically similar outcomes to those of surgery in recalcitrant type 1 ME. PRP can be considered as an alternative to surgery in the treatment of recurrent ME, with an earlier time to full ROM and time to pain-free status compared with surgery.
Medial epicondylitis, commonly referred to as golfer's elbow, is a condition primarily caused by the degeneration of the common flexor tendons' origin. The clinical presentation is mainly characterized by persistent elbow pain. Treatment options range from nonoperative measures to operative interventions. Surgical options become a consideration when symptoms persist for more than 6 months. In this literature review, a computer-assisted literature search has been conducted by the authors, looking into the databases of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, ProQuest, OvidSP, and Scopus. Based on that, 14 articles were selected and reviewed. Selected articles were those that reported outcomes of medial epicondylitis solely; the outcomes were assessed as each article separately; then, articles were collected based on the surgical techniques, and the mean values were estimated for success rates. The literature supports that surgical management for persistent medial epicondylitis is successful because it has a success rate ranging from 82.5% to 94.8% regardless of the technique used. Patients experienced improved symptoms and minimal complications, whereas minimally invasive procedures reported lower incidences of postoperative hematomas and ulnar neuropathy. Undergoing a surgical treatment leads to improvements in patients' symptoms. The choice of surgical procedure, however, should be individualized to ensure a balance between complications and coexisting pathologies.
Introduction: While commonly referred to as “golfer's elbow,” medial epicondylitis (ME) is a syndrome that more frequently presents in overhead throwing athletes and manual laborers. Repeated eccentric loading of the common flexor tendon attachment to the medial epicondyle leads to a spectrum of inflammation, microtrauma, and degeneration. Ulnar neuritis may be present in up to 60% of patients with ME, and its identification is imperative as up to 63% of these patients will experience persistent neurological symptoms. This review sought to provide a comprehensive reference for the current management of ME. Treatment and outcomes: Conservative management remains the mainstay for ME, with up to 85–95% of patients responding to initial treatment. Possible combinations for conservative treatment include trials of topical and/or oral NSAIDs, physical therapy, reduced activity levels, corticosteroid injections, electrical stimulation, and iontophoresis. Despite initial response to therapy, many patients experience symptom recurrence and progress to surgical intervention. Operative interventions include a variety of open, percutaneous, and arthroscopic approaches, with technique selection depending on patient presentation as well as physician experience and preference. Novel interventions for refractory ME treatment include injections of neutrophil-reduced platelet-rich plasma, and transcatheter arterial embolization. Bone marrow aspirate injections have also demonstrated some success in patients with lateral epicondylitis, but this modality has not yet been studied in ME to date. Conclusions: While less frequently encountered when compared to other upper extremity pathologies, ME remains a clinically important topic due to the prevalence of refractory cases and the constantly evolving treatment possibilities for the condition.
Background
Medial epicondylitis (ME) is a pathological condition that arises in laborers and athletes secondary to repetitive wrist flexion and forearm pronation causing degeneration of the common flexor tendon. Although nonoperative management has demonstrated high rates of success, no standardized surgical technique has been established for situations when operative management is indicated.
Purpose/Hypothesis
The purpose of this study was to perform a systematic review of the surgical treatment options for ME and evaluate the associated patient-reported outcomes (PROs). We hypothesized that surgical management of ME would vary across studies but no technique would prove to be superior.
Study Design
Systematic review; Level of evidence, 4.
Methods
Searches were conducted using PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature (CINAHL), SPORTDiscus, and Cochrane databases between 1980 and April 2020. All level 1 to 4 studies were identified that focused on surgical management and PROs in the setting of ME. Description of surgical technique and PROs were required for inclusion. Investigators independently dually abstracted and reviewed the studies for eligibility. Weighted means were calculated for demographic characteristics and available PROs.
Results
Overall, 851 studies were identified according to the search criteria. A total of 16 studies met the inclusion and exclusion criteria and therefore were evaluated. Three surgical techniques were found: open (13 studies), arthroscopic (2 studies), and percutaneous (1 study). Descriptions of the open technique were subdivided into those with (7 studies) and without (6 studies) common flexor tendon repair. Analysis included 479 elbows; patients were primarily male (58.3%) with a weighted mean age of 47.2 years. Weighted mean follow-up was 4.6 years. Tennis and manual laborer were the most common sport and occupation, respectively. Surgical success ranged from 63% to 100%, with a low complication rate of 4.3%. Success rates for return to sports and work were 81%-100% and 66.7%-100%, respectively, and only 1 study reported a return to work rate <90%.
Conclusion
This systematic review demonstrates that surgical intervention for refractory ME often has a high success rate. Regardless of surgical technique performed, patients generally demonstrated an improvement in PROs, and an encouraging number returned to work with limited complications. Further investigation is necessary to determine superiority among open, arthroscopic, and percutaneous techniques.
Epicondylitis of the elbow is a common cause of elbow pain, with lateral epicondylitis occurring more frequently than medial epicondylitis. Both lateral and medial epicondylitis are thought to arise from repetitive overuse of the elbow due to occupational or recreational activities, resulting in an insidious onset of pain around the lateral or medial epicondyle. This pain usually is worsened with grip, lifting, resisted wrist extension in lateral epicondylitis, and wrist flexion in its medial counterpart. MRI can provide valuable information about concomitant pathology but may not be predictive of epicondylitis symptomology. Conservative management is successful in the majority of cases and includes periods of rest, ice, physical therapy, activity modification, anti-inflammatory medication, injections (including corticosteroid, platelet-rich plasma, and botulinum toxin), and counterforce bracing. Surgical intervention, through an open or arthroscopic approach, may be necessary in recalcitrant cases. While both open and arthroscopic surgical approaches are well established and provide excellent outcomes with decreased pain and improved function, arthroscopic management offers additional advantages. Such benefits of arthroscopic treatment include lower surgical site infection rates and the potential for a quicker return to work and recreational activities.KeywordsEpicondylitisMedialLateralArthroscopicTendinosisTennisGolfersElbow
