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