The Journal of Bone and Joint Surgery, Vol 77, Issue 7 1065-1069, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow
GT Gabel and BF Morrey
Mayo Clinic, Rochester, Minnesota 55905, USA.
We performed a retrospective review of the long-term results of operative
treatment of medial epicondylitis in thirty elbows (twenty-six patients).
Sixteen elbows had concomitant ulnar neuropathy. All of the patients had
tenderness over the medial epicondyle. The most sensitive provocative
maneuver was resisted pronation of the forearm (a positive result for
twenty-eight elbows), followed by resisted flexion of the wrist (a positive
result for twelve elbows). The operative findings included an inflammatory
focus in seventeen elbows and focal ulnar-nerve compression in nine.
Debridement of the origin of the flexor-pronator tendon mass, with
decompression or transposition of the ulnar nerve when indicated, was
associated with an 87 per cent rate (twenty-six elbows) of good or
excellent results at an average of seven years (range, two to fifteen
years) after the operation. Twenty-four of the twenty-five elbows that had
no or mild associated ulnar neuropathy (type-IA or IB medial epicondylitis)
had a good or excellent result, while two of the five elbows that had
moderate or severe associated ulnar neuropathy (type-II medial
epicondylitis) had a good or excellent result. This difference was
significant (p = 0.009). Nine patients (nine elbows) needed more than six
months before maximum improvement was obtained.
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