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Dr MARC BEAUCHAMP MD FRCSC
Private orthopedic surgery clinic, Montreal, Canada Shoulder and elbow surgery, arthroscopy
Private orthopedic surgery Montreal, Canada
Elbow Elbow anatomyCommon problemsTendinitis of the elbow, lateral epicondylitisTendinitis of the elbow, medial epicondylitisTendinitis of the elbow, distal bicepsOsteoarthritis of the elbow
Shoulder anatomy

Tendinitis of the elbow – Medial epicondylitis (golfer's elbow)

The pain can be likened to that of lateral epicondylitis except that it occurs on the inside of the elbow. It mainly involves the round pronator muscles (involved in internal rotation of the forearm or pronation) and the finger flexors.

Conservative treatment is the norm. The more sceptical among us will tell you to extend any type of treatment for six to eight weeks. In short, most cases of medial epicondylitis resolve over time.

Cortisone injections are rarely necessary and care must be taken to avoid adjacent structures such as the ulnar nerve.

Imaging by MRI or ultrasound will be ordered if the clinical response to conservative treatment is poor or very slow (to investigate for tendinopathy or a partial tear).

Surgery (debridement or release under local anesthesia) is a last resort for people who show no signs of improvement after six months of treatment. It is preceded by a lidocaine test (injection of anesthetic into the medial epicondyle) to provide temporary pain relief. If the test is negative, surgery is not necessary, but if it is positive, the chances of the operation being successful are over 90%. However, postoperative healing takes a little longer than for lateral epicondylitis (complete healing takes 6 to 12 months).

Complications are rare (less than 1%) and extra care must be taken to avoid the ulnar nerve.

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