Other popular names
- Medial Epicondylitis
Who does it affect?
Why does it happen?
The cause of this condition is unclear and somewhat controversial. It is most likely due to a problem with the tendons that insert onto the inner edge of the elbow.
Medial epicondylitis is inflammation at the point where the tendons of the forearm attach to the bony prominence of the inner elbow. As an example, this tendon can become strained in a golf swing, but many other repetitive motions can injure the tendon. Golfer's elbow is characterised by local pain and tenderness over the inner elbow. The range of motion of the elbow is preserved because the inner joint of the elbow is not affected. Those activities which require twisting or straining the forearm tendon can cause pain and worsen the condition.
The tender point is very well localised to the inner edge of the elbow and I will probably ask you to flex your wrist forwards against resistance. If this reproduces or increases your pain it is likely you have golfers elbow.
An x-ray may be taken.
Physiotherapy settles the majority of cases using a variety of techniques. A golfers elbow splint can also offer benefit.
The treatment of medial epicondylitis includes ice packs, resting the elbow, and nonsteroidal anti-inflammatorydrugs (NSAID’s). A steroid injection into the tendon / bone area may improve the symptoms. I only perform steroid injections once as further attempts may damage the overlying fat and skin causing a lightening of the skin and a hollow depression. If you still have symptoms following an injection it is likely that I will offer you the choice of surgery at this point.
Surgery is carried out as a day case procedure usually under a general anaesthetic and takes about 15 minutes.
The surgery is performed through a 5cm incision, the skin is incised and then the underlying fat is retracted. At the base of the wound is the common flexor origin (the muscle/bone junction for the muscles that flex the wrist forwards). This area is released off the bone and the underlying bone surface is nibbled to provide a healthy bed for the tendons to stick back down. Local anaesthetic is infiltrated into the skin edges. The skin is sutured and a bulky dressing is applied.
You can go home soon after the operation. The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The arm should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers and elbow from day 1. The dressing will be removed soon after your operation. The wound is cleaned and redressed with a simple dressing. Avoid forced gripping or lifting heavy objects for 6 weeks. The sutures are removed at about 12 days. You should notice an improvement in symptoms within a few weeks but the final result may take some 3-6 months.
Return to normal routine
Keep the wound dry until the stitches are out at 12 days.
Return to driving:
The hand needs to have full control of the steering wheel and left hand the gear stick. You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.
Return to work:
Everyone has different work environments. Returning to heavy manual labour should be avoided for approximately 4 - 6 weeks. You will be given advice on your own particular situation.
Overall over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<2% people suffer a reaction to surgery with painful stiff hands, which can occur with any elbow surgery from a minor procedure to a complex reconstruction).
- Failure to completely resolve the symptoms (approximately 1%) - this may be due to failure to completely release the area. This is rare, but may be released again.
- Blood vessel damage