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Open Repair of the Flexor Pronator Tendon for Management of Recalcitrant Medial Epicondylitis

March 01, 2019

Contributors: Christopher S Ahmad, MD, FAAOS; Matthew Joseph James Anderson, MD; Michael Constant; George Popa; David Trofa, MD; Julian Sonnenfeld, MD; Julian Sonnenfeld, MD

Medial epicondylitis, which also is known as golfer’s elbow, is a common orthopaedic condition that typically results from overuse of the flexor pronator mass. Repetitive eccentric loading of the muscles responsible for wrist flexion and forearm pronation leads to microtrauma and subsequent degeneration of the flexor pronator tendon. Occasionally, medial epicondylitis may result from an acute traumatic event. Patients with medial epicondylitis typically are in their forties to sixties and have an insidious onset of medial elbow pain. Physical examination often reveals tenderness and swelling localized to the medial epicondyle that is exacerbated with resisted wrist flexion and forearm pronation. Patients should be examined for concomitant elbow pathologies, including ulnar neuritis and ulnar collateral ligament injury. Increased signal intensity observed in the flexor pronator tendon on T2-weighted MRI indicates medial epicondylitis. Nonsurgical management is the mainstay of treatment; however, surgical treatment may be indicated in elite athletes and patients with persistent symptoms after 4 to 6 months of nonsurgical treatment. This video demonstrates open débridement and repair of the flexor pronator tendon, with an emphasis on restoration of the anatomic footprint and compression across the repair site to promote biologic healing. In addition, the typical presentation and MRI findings associated with medial epicondylitis are discussed, and the rehabilitation protocol for patients who undergo open repair of the flexor pronator tendon is presented.