Current concepts of natural course and in management of medial epicondylitis: a clinical overview

Abstract

Medial epicondylitis (ME), called "golfer's elbow", is not frequent or serious disease but can cause symptoms that are bothersome in everyday life. Therefore knowledge about this condition may improve diagnostic-therapeutic process. In this article detailed information concerning pathophysiology and symptomatology of ME was described. Great attention was paid to issues related to the diagnosis of the disease both in terms of differentiation with other elbow disorders as well as examination techniques. Finally, current therapeutic options were presented in detail and their efficacy was discussed based on the available data.

Keywords: CFT; ME treatment; common flexor tendon; golfer’s elbow; medial epicondylitis.

Figure 1.. Anatomical diagram showing the site of common attachment of flexors (EFT) - blue area and the medial collateral ligament complex, dark-gray – anterior part, light-gray - posterior part, the transverse part is marked in yellow.

Figure 2.. Ulnar nerve neuropathy, a - long axis view, arrows - swollen part of the ulnar nerve, arrow heads - narrowed part of the nerve, b - short axis view, dotted area - swollen part of the nerve.

Figure 3.. Post-traumatic scarrifications in the CFT attachment and in within the medial collateral humero-ulnar ligament – dotted area, ME – medial epicondyle.

Figure 4.. Position of the probe to obtain a CFT image in longitudinal (a) and transverse (b) sections and a correct ultrasound image of CFT in longitudinal (c) and transverse (d) sections; ME - medial epicondyle, open arrows - CFT, white arrow head - median nerve.

Figure 5.. A case of a simple enthesopathy, visible thickening, decreased echogenicity and segmental disappearance of the typical filamentous echostructure.

Figure 6.. A case of advanced enthesopathy with formation of calcifications due to damage to the CFT structure, a. longitudinal image view, b. transverse image view. ME – medial epicondyle.

Figure 7.. CFT. On the left a 2d, B-mode view, on the right an elastographic image.

Figure 8.. Injection of medial epicondylitis.

Figure 9.. A case of CFT enthesopathy treated with a single PRP injection, in each section 1-3, on image 1 -longitudinal, 2- transvers, 3 – power Doppler scans are posted, series a – just before injection – 1,2 - the CFT attachment has reduced echogenicity, it is slightly thickened (well seen on a-2 scan), a pour fibrous echostructure is visible, in the power Doppler mode, a single vessels are visible, which can be considered normal; b – a week after injection, 1,2 a reduction in the size of the hypoechoic area is seen, and enhanced second-degree vascularization is observed in the power Doppler mode; c - 4 weeks after injection, 1,2 - reduction of hypoechoic area is visible, the fibrillary echostructure of the attachment begins to renew, the features of increased vascularization disappeared in the power Dopler mode.