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Year |
2001 |
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Question Number |
274) |
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Category |
Select |
Question
Which of the following is considered the most common complication of an extensive release for resistant medial epicondylitis?
1) ulnar palsy
2) medial elbow instability
3) wrist flexion weakness
4) forearm pronation weakness
5) elbow flexor weakness
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Answer (click for answer)
Preferred response # 2
Medial epicondylitis or Golfer’s elbow is less frequent than lateral epicondylitis and usually responds to nonoperative therapy. The most common complication following an extensive release is damage to the medial collateral ligament at the time of surgery. The surgery involves making a 10-12cm incision centered over the medial epicondyle. Cutaneous nerves are protected during the superficial dissection. The common flexor origin is detached by sharp dissection and reflected. Any abnormal tissue seen is then excised. The medial epicondyle is then stripped of soft tissue and drilled with small holes. The common flexor origin is then reattached. The medial collateral ligament is composed of two bundles and anterior and a posterior. The anterior bundle is the major restraint to valgus rotation. The anterior bundle originates from the inferior most aspect of the medial epicondyle and thus is susceptible to injury during surgery. An ulnar palsy is certainly a possible intraoperative complication but the incidence is low most likely secondary to heightened awareness during the dissection. Wrist flexion weakness was not a common complication and the muscles responsible ( flexor carpi radialis, palmaris longus, and flexor carpi ulnaris) heal to the bone well after the surgery. Forearm pronation weakness is also not common. The pronator teres has two sites of origin the first from the medial epicondyle and the second from the coronoid process of the ulna. Elbow flexor weakness is also uncommon the muscle responsible the biceps brachii, coracobrachialis and brachialis all attach distal to the medial epicondyle.
Reference: Callaway, F.H., Field, L.D., Deng, D.H., et al.: Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone and Joint Surgery American 1997;79:1223-1231
Vangness, C.T., Jobe, F.W.: Surgical treatment of medial epicondylitis: Results in 35 elbows. J Bone and Joint Surgery British 1991;73:409-411