Surgical management for refractory medial epicondylitis based on the anatomical characteristics of flexor pronator origin: surgical results of 8 cases and review of the literature

Abstract

Background: This case series aimed to introduce surgical management for refractory medial epicondylitis based on the anatomical characteristics of the flexor pronator origin and present the surgical results. Methods: Ten elbows from 8 patients (2 males and 6 females; mean age 50.2 years) were included in this case series. All patients underwent resection of the degenerated anterior common tendon and repair using suture anchors. Ulnar neuritis was observed in 9 elbows of 7 patients who underwent the relevant additional surgery. Results: Medial elbow pain was resolved in all patients, and pain provocation tests (wrist flexion test and forearm pronation test) were negative postoperatively. The mean Patient-Rated Elbow Evaluation (Japanese version) score was significantly improved from 79.6 ± 7.7 (range, 64.3-92) preoperatively to 8.4 ± 15.2 (range, 0-50) at the final follow-up. Conclusion: Angiofibroblastic tendinosis of the anterior common tendon might be an essential pathology of medial epicondylitis, and anterior common tendon resection and repair could be the most appropriate treatment for medial epicondylitis.

Keywords

• Medial epicondylitis
• Flexor-pronator muscles
• Anterior common tendon
• Angio-fibroblastic tendinosis
• Ulnar neuritis
• Case series