| Introduction |
 An overuse syndrome of the flexor-pronator mass- Epidemiology
- 5X less common than lateral epicondylitis
- affect men and women equally
- and more difficult to treat than lateral epicondylitis
- Mechanism
- found in activities that require repetitive wrist flexion/forearm pronation
- common in golfers, pitchers, racquet sports, plumbers
- Pathoanatomy
- micro trauma to insertion of flexor-pronator mass caused by repetitive activities
- PT and FCR are most affected
- inflammation may affect to ulnar nerve
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| Anatomy |
- Flexor-pronator mass includes
 Pronator Teres (median n.)- Flexor Carpi Radialis (median n.)
- FDS (median n.)
- Palmaris Longus (median n.)
- Flexor Carpi Ulnaris (ulnar n.)
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| Presentation |
- Symptoms
- pain over medial epicondyle worse with wrist flexion and forearm pronation
- Physical exam
- tenderness over the origin of PT and FCR at the medial epicondyle
- provocative tests
- pain with resisted pronation and wrist flexion
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| Imaging |
- Radiographs
- MRI
- may show tendinosis of pronator teres and FCR
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| Differential |
- MCL injury
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| Treatment |
- Nonoperative
- NSAIDS, ice, activity modification, PT, bracing, corticosteroid injections
- indicated as first line of treatment
- technique
- counter-force bracing
- ultrasound shown to be beneficial
- multiple corticosteroid injections should be avoided
- Operative
- open debridement of PT/FCR, reattachment of flexor-pronator group
- indications
- 6 months of nonoperative management fails in compliant patient
- symptoms severe and affecting quality of life
- outcomes
- good to excellent outcomes in 80% (less than lateral epicondylitis)
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| Techniques |
- Open debridement and reattachment of flexor-pronator group
- approach
- technique
- excise regions of pathology
- enhance vascular environment
- reattach flexor-pronator mass to medial epicondyle
- rehab
- short period of immobilization
- ROM exercises
- avoid volar flexion of wrist in immediate postoperative period
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| Complications |
- Medial antebrachial cutaneous nerve neuropathy
- may result from avulsion or transection
- if injury noticed during surgery, than transpose nerve into brachialis muscle
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