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. Platelet rich plasma (PRP) injection, which is the patient’s own blood centrifuged to augment the platelet concentration and then re-injected at the tendon site, is growing in popularity, providing a 70% plus healing rate. We practice it under ultrasound Imaging in our office, providing there are no prior serious tear at US évaluation of the tendon.
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.
“Just wow!!! I was in so much pain for over a year waiting for my injury to heal. I finally decided to get surgery. My osteopath spoke to me about Dr Beauchamp. Told me he was the best… Surgery went amazingly… Well worth the money.“