Introduction
Medial epicondylitis or “golfer’s elbow” is a chronic and painful condition of the tendon attachment on the medial side of your elbow. At the bony prominence on your elbow there is an attachment of five muscles (common flexor origin). With normal wear and tear, this attachment can separate from the bone and it is this separation which produces the pain you have been experiencing.
Indications
When the tendon has separated from the bone, pain results. Depending on the size of the tear, especially if it is small, the pain may spontaneously resolve. Stretching and strengthening may also help with the aid of physiotherapy. Occasionally a cortisone injection helps the pain but mostly the effects are short-lived. When all of this fails to settle your pain, a reconstructive operation is indicated.
Preoperative Instructions
There is no major preparation required for this operation. It can be done as soon as it is clear the pain is not going to resolve with non-operative therapy.
Procedure
Operations for golfer’s elbow have always had a bad reputation and with good reason. The operation to cut the tendon disturbs the mechanics of the elbow and can result in other problems. Our operation is specifically designed to preserve normal elbow mechanics and to restore the normal anatomy of the common flexor origin. A small incision is made over the bony prominence on the medial side of your elbow. The first thing that is done it the ulnar nerve is identified in the groove behind the tendon and dissected free to ensure any compression of the nerve is relieved. It also ensures it is protected while the tendon is reconstructed. After the tendon has been dissected from its attachment where it has been partially torn, it is cleaned up and refixed to the bone with sutures passed through tunnels in the bone. Because this makes the elbow quite sore for a day or so, a splint is applied and a long acting local anaesthetic is used to relieve the pain after the operation enabling you to go home the same day.
Postoperative Instructions
For the first ten to fourteen days until wound healing has occurred, the elbow is rested in a sling and splint. When the sutures are removed after the wound has healed, gentle active movements are commenced. This limited activity level remains for a month until the tendon has firmly healed onto the bone. Physiotherapy commences then and active and vigorous training to strengthen the muscles is encouraged.
Risks
All operation can have complications and this is no exception. The most common complication is post-operative pain and bleeding from the wound, which is lessened by local anaesthetic injection into the wound and the use of a splint. The next most common problems are wound infection (one case in a smoker), DVT (prior history of clotting). There could be some damage to the ulnar nerve as well but the dissection is designed to protect it at all times. This is a very safe operation.
Treatment Alternatives
By the time you decide to have surgery, it is likely you will have had quite a few different treatments for you elbow pain all of which by now will have not been helpful. Surgery is recommended for those elbows which do not respond to non-operative treatment.