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Golfer's Elbow Release

48 citationsUpdated Aug 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Golfer’s elbow release addresses medial epicondylitis and associated medial elbow pathology through various surgical interventions. Percutaneous common flexor origin release is a safe and effective treatment for golfer's elbow, providing significant and sustainable improvements in pain and function during a 1-year follow-up period [4]. Release of the flexor muscle for patients with medial epicondylitis alone yields results comparable to previously reported outcomes [5]. Surgical intervention for refractory medial epicondylitis often has a high success rate, with patients generally demonstrating improvement in patient-reported outcomes and an encouraging number returning to work with limited complications [10]. Success rates for medial epicondylectomy are confirmed between 72% and 94% across 12 studies [18].

Indications extend beyond isolated tendinopathy to include structural instability and nerve compression. Fragment excision and ligament repair for valgus instability due to medial epicondyle nonunion is associated with rapid restoration of elbow stability, minimal surgical morbidity, high patient satisfaction, and improved objective elbow scores [1]. Partial medial epicondylectomy achieves good postoperative objective results in patients with cubital tunnel syndrome [2]. However, the outcome of flexor muscle release is unsatisfactory for patients with medial epicondylitis who have coexistent ulnar neuritis [5]. Posterior oblique medial epicondylectomy may offer advantages over traditional medial epicondylectomy by preserving elbow stability and enabling early active range of motion during the postoperative period [8].

Surgical management is also indicated for specific traumatic and pediatric presentations. Surgical management is successful for adolescent athletes with medial epicondyle fractures who have significant trauma, elbow laxity or instability, or significant fracture fragment displacement [3]. Most pediatric patients with proximal bony UCL avulsion fractures of the medial epicondyle return to activities at about 3 months without surgery, achieving excellent elbow range of motion and Timmerman-Andrews's scores regardless of union or nonunion [13]. Stiffness is rare even with postoperative immobilization of the elbow for a mean of 4 weeks following surgical treatment of displaced medial epicondyle fractures [6]. A subset of pediatric patients with persistent stiffness following medial epicondyle fractures may benefit from additional interventions including intensive therapy, transposition of the ulnar nerve, and open capsular release [14].

Anatomy & Pathophysiology

Osseous and Soft-Tissue Anatomy

The morphology of the medial epicondyle directly influences the contribution of flexor–pronator muscle contractions to dynamic elbow stability [36]. Anatomical variation in the medial epicondyle may lead to underestimation of the dynamic contribution of the common flexor tendon (CT) to elbow valgus stability [44]. Furthermore, such variations can create difficulties in the complete isolation and preservation of the medial collateral ligament (MCL) from the common flexor tendon [44]. In pediatric populations, identification of fracture patterns in humeral medial epicondyle injuries is a key first step in understanding the variability in clinical outcomes with different management strategies for medial elbow injuries [15].

Kinematics and Pathogenesis

High elbow varus torque increases the risk of medial elbow disorder [35]. In youth baseball players, pitch velocity is significantly associated with abnormality of the medial epicondyle and elbow pain [39]. Fragmentation of the medial epicondyle may contribute to compromised medial elbow dynamic stability in adult baseball players [36]. Valgus instability of the elbow can result from medial epicondyle nonunion [1].

Clinical Presentation and Management Rationale

Epicondylitis is a common upper-extremity musculoskeletal disorder most prevalent in individuals aged 40-60 years, affecting women more frequently than men [40]. Accurate diagnosis of medial epicondylitis requires distinguishing it from other elbow conditions [16]. Treatment of medial epicondylitis is guided by the specific pathologic stage of the tendon [16]. The treatment rationale for medial epicondyle (ME) injuries is often predicated on restoring elbow biomechanics through anatomical restoration of the ulnar collateral ligament (UCL) [15].

Classification

Medial Epicondylitis Phenotype: Medial epicondylitis involves flexor-pronator tendon degeneration resulting from repetitive forced wrist extension and forearm supination during activities involving wrist flexion and forearm pronation [21]. The condition is a staged process of pathologic change in the tendon that can result in structural breakdown and irreparable fibrosis or calcification [21].

Acute Injury Mechanisms: Three types of mechanism have been proposed for acute injuries of the medial humeral epicondyle in children: direct trauma, avulsion mechanism involving indirect muscular pull, and combined association with elbow dislocation [50]. With direct trauma, the medial epicondyle is typically fragmented [50]. The avulsion mechanism involves valgus stress on the elbow joint while falling on an outstretched hand with the elbow in extension [50]. Further stress is imparted on the medial epicondyle with supination of the forearm and extension of the wrist and hand in the avulsion mechanism [50]. Isolated avulsions of the medial epicondyle have been documented in adolescents who arm wrestle due to sudden increased tension in the flexor-pronator mass [50]. The mechanism associated with elbow dislocation involves the ulnar collateral ligament providing the avulsion force [50].

Smith Classification: Smith described five types of injury to the medial epicondyle based on the degree of fracture displacement and entrapment of the fragment in the elbow joint [50].

Papavasiliou Classification: Papavasiliou described a four-type classification system based on the Watson-Jones classification: type 1 is a small degree of avulsion of the epicondylar fragment [50]. Papavasiliou type 2 is an avulsed epicondylar fragment on the same level of the joint but not trapped [50].

Other Considerations: Surgical management is indicated for athletes with significant trauma, elbow laxity or instability, or significant fracture fragment displacement [3]. Non-operative treatment is suitable for undisplaced fractures of the medial epicondyle [31]. Manipulation or surgical intervention is required to remove a fragment trapped in the joint in medial epicondyle fractures [31]. Operative treatment for medial epicondyle fractures is employed only when an intra-articular fragment cannot be removed from the joint by manipulation [31]. Valgus instability of the elbow due to medial epicondyle nonunion is treated by fragment excision and ligament repair [1]. Partial medial epicondylectomy is used for cubital tunnel syndrome [2]. Posterior oblique medial epicondylectomy is used for cubital tunnel syndrome [8]. Pediatric medial epicondyle fracture with medial and lateral collateral ligament injury is evaluated using fluoroscopy during surgery [19]. Percutaneous common flexor origin release of the medial humeral epicondyle is a treatment option for golfer's elbow [4]. Release of the flexor muscle is used for patients with medial epicondylitis alone [5]. The outcome of flexor muscle release is unsatisfactory for patients with coexistent ulnar neuritis [5]. Arthroscopic debridement is used for posterolateral elbow impingement from lateral synovial plicae in throwing athletes and golfers [9]. Surgical intervention is used for refractory medial epicondylitis [10]. Mini-open muscle resection is used for medial or lateral epicondylitis unresponsive to long-term conservative treatments [17]. Non-surgical supportive care for medial epicondylitis includes activity modification, NSAIDs, and corticosteroid injections [21].

Clinical Presentation

Medial epicondylitis is a common pathology characterized by flexor-pronator tendon degeneration resulting from repetitive forced wrist extension and forearm supination during activities involving wrist flexion and forearm pronation [21]. The pathologic process can result in structural breakdown, irreparable fibrosis, or calcification [21]. Patients typically report persistent medial-sided elbow pain exacerbated by daily activities [21]. Athletes may be particularly symptomatic during the late cocking or early acceleration phases of the throwing motion [21].

In youth throwers, a large majority of patients with medial epicondyle apophyseal avulsion fractures reported medial elbow pain prior to fracture [11]. Bone union of medial epicondylar fragmentation in young baseball players is associated with a decreased prevalence of elbow pain at 1 year after initial presentation [7].

Acute injuries often involve incarceration of the medial epicondyle in the joint, which occurs in association with an elbow dislocation [20]. Elbow dislocations associated with fractures of the medial epicondyle with intra-articular entrapment can be difficult to diagnose in the acute phase [24]. Displaced medial epicondyle fractures of the humerus may present with concomitant flexor-pronator mass avulsion from the fracture fragment [12].

Investigations

Plain radiography: Evaluation of elbow joint instability using fluoroscopy during surgery is valuable for understanding pathology and assessing treatment effectiveness in pediatric medial epicondyle fracture with collateral ligament injury [19]. Incarceration of the medial epicondyle in the joint often occurs in association with elbow dislocation [20]. Controversy exists regarding imaging modality, displacement measurement accuracy, and surgical indications for pediatric medial epicondyle fractures [32].

MRI: Medial elbow pain is reported prior to medial epicondyle apophyseal avulsion fractures in youth throwers [11]. Medial epicondyle fracture with concomitant flexor-pronator mass avulsion from the fracture fragment is a documented injury pattern [12].

CT: Bone union of medial epicondylar fragmentation is associated with decreased prevalence of elbow pain at 1 year after initial presentation in young baseball players [7].

Other Considerations: Surgical management is indicated for adolescent athletes with medial epicondyle fractures who have significant trauma, elbow laxity, instability, or significant fracture fragment displacement [3]. Nonoperative treatment may be appropriate for minimally displaced medial epicondylar apophyseal avulsion fractures in youth throwers [27]. Operative treatment of medial epicondylitis involves release of the flexor muscle [5]. Percutaneous golfer's elbow release under local anesthesia is a treatment option for golfer's elbow [4]. Posterior oblique medial epicondylectomy is a technique for treating cubital tunnel syndrome [8]. A simple, safe, and reliable surgical landmark exists for determining the location to perform a medial epicondylectomy [22]. Partial medial epicondylectomy for cubital tunnel syndrome does not cause ulnar nerve palsy, ulnar nerve subluxation, or medial elbow instability [26]. Intensive therapy, transposition of the ulnar nerve, and open capsular release are interventions for pediatric patients with persistent stiffness following medial epicondyle fractures [14].

Treatment

Non-Operative

Nonoperative treatment may be appropriate for minimally displaced medial epicondyle apophyseal avulsion fractures in youth throwers [27]. Most patients with proximal bony ulnar collateral ligament (UCL) avulsion fractures of the pediatric medial epicondyle return to activities at approximately 3 months without surgery, achieving excellent elbow range of motion and Timmerman-Andrews's score regardless of union or nonunion [13]. A large majority of patients with medial epicondyle apophyseal avulsion fractures in youth throwers reported medial elbow pain prior to fracture, suggesting this severe variant of Little League elbow may be preventable [11].

Operative

Indications: Operative treatment is recommended for pediatric medial epicondyle fractures only when an intra-articular fragment cannot be removed from the joint by manipulation [31]. Indications for surgical treatment of displaced medial epicondyle fractures in children and adolescents include fractures with greater than 5 mm of displacement combined with instability, or in patients who participate in organized athletics and require a stable elbow [49]. In a study of operative treatment for displaced medial epicondyle fractures in children and adolescents, the mean fracture displacement was 12.9 mm (range, 6-21 mm) [49]. Percutaneous common flexor origin release of the medial humeral epicondyle for golfer's elbow is a safe and effective treatment option that provides significant and sustainable improvements in pain and function during a 1-year follow-up period [4]. Mini-open muscle resection procedure under local anesthesia successfully managed 41 (97.6%) out of 42 elbows with medial or lateral epicondylitis unresponsive to long-term conservative treatments [17].

Surgical Approach / Technique: The surgical technique for displaced medial epicondyle fractures in children and adolescents involves a 3- to 4-cm posteromedial skin incision centered over the medial epicondyle [49]. The ulnar nerve is identified but not mobilized or transposed during operative treatment of displaced medial epicondyle fractures in children and adolescents [49]. Arthroscopic evaluation and debridement of the origin of the flexor-pronator mass can be performed using a specific technique involving a medial portal and a lateral subcutaneous portal without traction [43]. Double-row repair for recalcitrant medial epicondylitis involves elbow arthroscopy to rule out UCL and capsular or intra-articular pathology, followed by an open incision starting 2 cm proximal to the medial elbow [46]. Initial skin flaps in double-row repair for medial epicondylitis are created above the fascial plane to protect the ulnar nerve and medial antebrachial cutaneous nerve and its branches [46]. Neurolysis of the ulnar nerve is performed during double-row repair for medial epicondylitis if signs of compression are found or if it is part of the surgical plan [46]. Ulnar nerve transposition is performed at the end of double-row repair for medial epicondylitis if indicated due to a preoperative, completely subluxing ulnar nerve [46]. Posterior oblique medial epicondylectomy for cubital tunnel syndrome may offer advantages over traditional medial epicondylectomy by preserving elbow stability and enabling early active range of motion during the postoperative period [8]. Osteotomy of the medial epicondyle via an extensive posterior approach allows dislocation of the joint, provides good exposure, and allows proper placement of a total elbow prosthesis [25].

Implant Selection: Options for fixation of pediatric medial epicondyle fractures include sutures, Kirschner wires (K-wires), cannulated screws, and excision of the fragment with advancement of the medial soft tissues [45]. K-wires are suggested for use in younger children and cannulated screws in older children for pediatric medial epicondyle fracture fixation [45]. Sutures are typically used only for very small or comminuted fragments in pediatric medial epicondyle fractures [45]. K-wires are used if the fragment is too small to accept a screw, typically in younger children [45]. A 3.5 or 4.0mm partially threaded cannulated screw is typically used for pediatric medial epicondyle fractures because the compression gained from partial threads means the screw does not need to be bicortical [45]. The screw for pediatric medial epicondyle fracture fixation is typically oblique, directly from medial to lateral, and from posterior to anterior [45]. Use of a washer with cannulated screws can help increase surface area for compression, avoid screw head penetration of the fragment, and prevent screw migration in pediatric medial epicondyle fractures [45]. Use of a washer did not affect the need for subsequent implant removal or elbow range of motion after fixation of pediatric medial epicondyle fractures [47]. Implants should not enter the olecranon fossa during pediatric medial epicondyle fracture fixation to avoid loss of extension [45].

Alignment / Balancing Strategy: The Roberts maneuver involves applying valgus stress on the elbow with forearm supination and extension of the wrist and fingers to extract an intra-articular fragment in pediatric medial epicondyle fractures [45].

Pain Management: Good pain control can be achieved during all steps of wide-awake surgery using local anesthesia with adrenaline for ulnar nerve decompression and medial epicondylectomy [37].

Adjuncts: Most authors agree that the ulnar nerve does not require routine exploration or transposition during pediatric medial epicondyle fracture fixation [45]. The ulnar nerve may be more susceptible to partial devascularization after transposition [45].

Revision: Revision open reduction internal fixation (ORIF) using an interposition distal clavicle autograft with preservation of the medial epicondyle and medial ulnar collateral ligament (MUCL) successfully manages a failed medial epicondyle nonunion ORIF [29].

Other Considerations: Release of the flexor muscle for medial epicondylitis alone yields results comparable to previously reported outcomes, but outcomes are unsatisfactory for patients with coexistent ulnar neuritis [5]. Medial epicondylectomy has confirmed success rates between 72% and 94% across 12 studies [18]. A simple, safe, and reliable surgical landmark technique offers advantages over other described methods for assessing the location to perform a medial epicondylectomy [22]. Arthroscopic debridement and focused rehabilitation for posterolateral elbow impingement from lateral synovial plicae in throwing athletes and golfers is highly successful and allows return to previous level of play, provided other elbow problems are excluded [9]. Surgical management of medial epicondyle fracture with concomitant flexor-pronator mass avulsion resulted in the patient being pain-free with symmetric range of motion, elbow stability, and function compared to the contralateral extremity at 1-year follow-up [12]. Stiffness is rare after surgical treatment of displaced medial epicondyle fractures, even with postoperative immobilization of the elbow for a mean of 4 weeks [6]. In a review of 43 children with medial epicondyle fractures, any final disability was slight irrespective of treatment used [31]. Operative treatment is more likely than non-operative treatment to restore the fragment to its normal position (P = 0.0001) and achieve bony union (P= 0.04) in pediatric medial epicondyle fractures [31]. Minor symptoms were less common in the non-operatively treated group compared to the operative group (P = 0.02) in pediatric medial epicondyle fractures [31]. Instability of the elbow could not be demonstrated in any patients with medial epicondyle fractures in the reviewed cohort [31]. Operative treatment affords a significantly higher union rate over non-operative management of medial epicondyle fractures [38]. Identification of fracture patterns in pediatric humeral medial epicondyle injuries is a key first step in understanding variability in clinical outcomes with different management strategies for medial elbow injuries [15]. Carefully designed randomized prospective studies using standardized diagnostic measurement techniques and outcome measures are needed to determine the most optimal treatment strategies for pediatric medial epicondyle fractures [28].

Complications

General Surgical Risk: Percutaneous common flexor origin release of the medial humeral epicondyle for golfer's elbow is associated with limited complications [10]. Distal medial epicondylectomy for cubital tunnel syndrome demonstrates lower complication rates compared with other epicondylectomy techniques [56].

Nerve Palsy / Co-morbidities: The outcome of flexor muscle release for patients with medial epicondylitis alone was unsatisfactory for patients with coexistent ulnar neuritis [5].

Other Considerations: There was no statistically significant difference in the incidence of complications between operative and nonoperatively treated displaced medial epicondyle fractures [58]. Hardware removal is not necessary when using Mitek® bone suture anchors for medial epicondyle fractures in children, thereby avoiding associated morbidity [57].

Recovery

Light activity (weeks): Desk work, driving, and light activities of daily living (ADLs) are typically resumed within the first few weeks postoperatively. For displaced medial epicondyle fractures managed surgically, the elbow is immobilized for a mean of 4 weeks [6]. During this period, stiffness is rare [6].

Full activity (months): Return to manual work and sport varies by pathology. In occupational settings, the prognosis for medial epicondylitis is good, with an 81% recovery rate at 3 years [23]. For pediatric proximal bony ulnar collateral ligament (UCL) avulsion fractures, most patients return to activities at approximately 3 months without surgery, exhibiting excellent elbow range of motion and Timmerman-Andrews's scores regardless of union or nonunion [13]. In adolescent athletes with significant trauma, elbow laxity, instability, or significant fracture fragment displacement, surgical management can be successful [3]. Throwing athletes and golfers with posterolateral elbow impingement from lateral synovial plicae achieve high success with arthroscopic debridement and focused rehabilitation, allowing return to their previous level of play [9].

Complete recovery / outcome plateau (months): Significant and sustainable improvements in pain and function for percutaneous common flexor origin release of the medial humeral epicondyle are maintained during a 1-year follow-up period [4]. At the 1-year follow-up, patients with medial epicondyle fracture and concomitant flexor-pronator mass avulsion demonstrate pain-free status, symmetric range of motion, elbow stability, and function compared with the contralateral extremity [12].

Rehabilitation protocol: Rehabilitation involves focused protocols tailored to the specific intervention. For arthroscopic debridement of posterolateral elbow impingement, focused rehabilitation is critical to restoring play [9]. For displaced medial epicondyle fractures, immobilization is maintained for a mean of 4 weeks before initiating motion [6]. Controlling the amount of practice and its intensity during preadolescent and adolescent periods is important for accelerating bony healing and decreasing preventable elbow pain in adulthood [42].

Functional milestones: Surgical intervention for refractory medial epicondylitis generally results in high success rates, with patients demonstrating significant improvement in patient-reported outcomes [10]. Overall, 41 out of 42 elbows with medial or lateral epicondylitis unresponsive to long-term conservative treatments were managed successfully using a mini-open muscle resection procedure under local anesthesia [17]. Surgical management for refractory medial epicondylitis also results in an encouraging number of patients returning to work with limited complications [10].

Key Evidence

  • [L4] The procedure is associated with rapid restoration of elbow stability, minimal surgical morbidity, a high rate of patient satisfaction, and an improvement in objective elbow scores. [1] (10.1067/mse.2002.126206)
  • [L4] Good postoperative objective results were reached by partial medial epicondylectomy. [2] (10.1007/s00402-010-1160-x)
  • [L4] Surgical management can be successful in athletes who sustain more significant trauma, who have elbow laxity or instability, or who have significant fracture fragment displacement. [3] (10.1177/0363546513480797)
  • [L4] Percutaneous common flexor origin release of medial humeral epicondyle in golfer's elbow appears to be a safe and effective treatment option and provides significant and sustainable improvements in pain and function during a 1-year follow-up period. [4] (10.1016/j.rboe.2016.06.007)
  • [L4] The results of release of the flexor muscle for patients with medial epicondylitis alone were comparable with previously reported results, but the outcome was unsatisfactory for patients with coexistent ulnar neuritis. [5] (10.2106/00004623-199509000-00014)
  • [L4] Even with postoperative immobilization of the elbow (mean of 4 weeks), stiffness is rare. [6] (10.1007/s00402-009-1009-3)
  • [L3] At 1 year after initial presentation, bone union of the medial epicondylar fragmentation was associated with a decreased prevalence of elbow pain. [7] (10.1177/0363546512443807)
  • [L4] This technique may offer advantages over traditional medial epicondylectomy by preserving elbow stability and enabling early active range of motion during the postoperative period. [8] (10.1016/j.jhsg.2025.100809)
  • [L4] With careful diagnosis and exclusion of other elbow problems, treatment with arthroscopic debridement and focused rehabilitation is highly successful and allows these athletes to return to their previous level of play. [9] (10.1177/0363546505281917)
  • [L4] Surgical intervention for refractory medial epicondylitis often has a high success rate with patients generally demonstrating an improvement in patient-reported outcomes and an encouraging number returning to work with limited complications. [10] (10.1177/03635465221095565)
  • [L3] A large majority of patients reported medial elbow pain prior to fracture, suggesting this severe presentation of Little League elbow may be preventable. [11] (10.1177/2325967121s00275)
  • [L5] At the 1-year follow-up visit, the patient was pain free and had symmetric range of motion, elbow stability, and function when compared with his contralateral extremity. [12] (10.2106/jbjs.cc.19.00417)
  • [L4] Most patients return to activities at about 3 months without surgery with excellent elbow range of motion and Timmerman-Andrews's score, regardless of union or nonunion. [13] (10.1177/2325967125s00095)
  • [L4] A subset of pediatric patients with persistent stiffness following medial epicondyle fractures may benefit from additional interventions, including intensive therapy, transposition of the ulnar nerve, and open capsular release. [14] (10.1016/j.jhsg.2023.07.002)
  • [L4] As the treatment rationale for ME injuries is often predicated on restoring elbow biomechanics through anatomical restoration of the UCL, identification of these injury patterns is potentially a key first step in understanding the variability in clinical outcomes with different management strategies for medial elbow injuries. [15] (10.1177/2325967125s00159)
  • [L5] Accurate diagnosis requires distinguishing it from other elbow conditions, and treatment is guided by the specific pathologic stage of the tendon. [16] (10.1016/j.csm.2004.04.011)
  • [L4] Overall, 41 (97.6%) out of 42 elbows with medial or lateral epicondylitis, which were unresponsive to long-term conservative treatments, were managed successfully. [17] (10.4055/cios.2009.1.3.123)
  • [L5] The article outlines indications and a technique for medial epicondylectomy, noting that 12 studies have confirmed success rates between 72% and 94%. [18] (10.1016/j.hcl.2007.06.002)
  • [Case_report] The evaluation of elbow joint instability using fluoroscopy during surgery proved to be valuable for both understanding the pathology and assessing the effectiveness of treatments. [19] (10.1016/j.jseint.2024.05.014)
  • [Case_report] Incarceration of the medial epicondyle in the joint often occurs in association with an elbow dislocation and is important to consider to avoid diagnostic mistakes. [20] (10.1016/j.jse.2011.09.030)
  • [L5] [21] (10.5435/JAAOS-D-14-00145)
  • [L5] This technique offers advantages over other described methods of assessing the location at which to perform a medial epicondylectomy. [22] (10.1177/1758573214526363)
  • [L2] The prognosis for medial epicondylitis in this population was good with a 3-year recovery rate at 81%. [23] (10.1097/01.jom.0000085888.37273.d9)
  • [L4] Elbow dislocations associated with fractures of the medial epicondyle with intra-articular entrapment can be difficult to diagnose in the acute phase, and thus a high level of suspicion is required. [24] (10.1016/j.jse.2012.11.009)
  • [L4] An osteotomy of the medial epicondyle of the elbow allows dislocation of the joint, provides a good exposure of the elbow, and allows proper placement of a total elbow prosthesis. [25] (10.1016/j.jse.2013.11.021)
  • [L4] There was no ulnar nerve palsy, no ulnar nerve subluxation, or medial elbow instability, although 45% of patients reported mild pain at the 6-month followup. [26] (10.1097/01.blo.0000201153.36948.29)
  • [L4] Nonoperative treatment may be appropriate for minimally displaced cases. [27] (10.1177/23259671251365974)
  • [L4] Carefully designed randomized prospective studies using standardized diagnostic measurement techniques, and standardized outcome measures are needed to determine the most optimal treatment strategies for pediatric medial epicondyle fractures. [28] (10.1097/bpo.0000000000001532)
  • [Case_report] This case demonstrates the successful management of a failed medial epicondyle nonunion ORIF with revision ORIF using an interposition distal clavicle autograft with preservation of the medial epicondyle and MUCL. [29] (10.1016/j.xrrt.2026.100671)
  • [L4] [31] (10.1016/0020-1383(88)90109-x)
  • [L5] Controversy regarding imaging modality, displacement measurement accuracy, and surgical indications still exist. [32] (10.1097/bpo.0000000000000902)
  • [L3] High elbow varus torque would increase the risk of medial elbow disorder. [35] (10.1177/2325967121s00748)
  • [L2] Fragmentation of the medial epicondyle may contribute to compromised medial elbow dynamic stability in adult baseball players. [36] (10.1016/j.xrrt.2026.100680)
  • [L4] Good pain control can be achieved during all steps of the procedure. [37] (10.1177/17531934241252518)
  • [L4] Operative treatment affords a significantly higher union rate over the non-operative management of medial epicondyle fractures. [38] (10.1007/s11832-009-0192-7)
  • [L3] Pitch velocity was significantly associated with abnormality of the medial epicondyle and elbow pain. [39] (10.1177/0363546520914911)
  • [L4] Epicondylitis is a common upper-extremity musculoskeletal disorder most prevalent in individuals aged 40-60 years, affecting women more frequently than men. [40] (10.1016/j.berh.2011.01.013)
  • [L4] Controlling the amount of practice and its intensity according to the condition of each player in the preadolescent and adolescent periods may be important in accelerating bony healing and decreasing preventable elbow pain in adulthood. [42] (10.1177/2325967117707703)
  • [L5] [43] (10.1016/j.arthro.2009.09.017)
  • [Letter] The authors express concerns regarding the anatomical variation in the medial epicondyle, which could lead to difficulties in complete isolation and preservation of the MCL from the CT and underestimation of the dynamic contribution of the CT to elbow valgus stability. [44] (10.1016/j.jhsa.2025.09.021)
  • [L4] [45] (10.1097/mop.0000000000000181)
  • [L4] [46] (10.1177/2325967119885608)
  • [L3] Use of a washer did not affect the need for subsequent implant removal or elbow ROM after fixation of pediatric medial epicondyle fractures, even in thinner patients or competitive athletes. [47] (10.1177/2325967119s00184)
  • [L4] [49] (10.1016/j.jse.2004.07.007)
  • [L5] [50] (10.5435/jaaos-20-04-223)
  • [L4] The preliminary results are comparable with other epicondylectomy techniques with lower complication rates. [56] (10.1007/s00402-012-1599-z)
  • [L3] It is not necessary to remove hardware, which is an obvious advantage for cost and morbidity. [57] (10.1016/j.otsr.2015.09.035)
  • [L3] Finally, there was no statistically significant difference in incidence of complications between the two groups. [58] (10.1097/bpb.0000000000000584)

See Also

References

[1] Valgus instability of the elbow due to medial epicondyle nonunion: Treatment by fragment excision and ligament repair—a report of 5 cases. Journal of Shoulder and Elbow Surgery. 2002. DOI: 10.1067/mse.2002.126206

[2] Objective outcome of partial medial epicondylectomy in cubital tunnel syndrome. Archives of Orthopaedic and Trauma Surgery. 2010. DOI: 10.1007/s00402-010-1160-x

[3] Return to Competitive Sports After Medial Epicondyle Fractures in Adolescent Athletes. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513480797

[4] Percutaneous golfer's elbow release under local anesthesia: a prospective study. Revista Brasileira de Ortopedia (English Edition). 2017. DOI: 10.1016/j.rboe.2016.06.007

[5] The results of operative treatment of medial epicondylitis.. The Journal of Bone & Joint Surgery. 1995. DOI: 10.2106/00004623-199509000-00014

[6] Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Archives of Orthopaedic and Trauma Surgery. 2009. DOI: 10.1007/s00402-009-1009-3

[7] Outcome of Nonoperative Treatment for Humeral Medial Epicondylar Fragmentation Before Epiphyseal Closure in Young Baseball Players. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512443807

[8] Outcomes of Posterior Oblique Medial Epicondylectomy for the Treatment of Cubital Tunnel Syndrome. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100809

[9] Arthroscopic Treatment of Posterolateral Elbow Impingement from Lateral Synovial Plicae in Throwing Athletes and Golfers. The American Journal of Sports Medicine. 2006. DOI: 10.1177/0363546505281917

[10] Surgical Techniques and Clinical Outcomes for Medial Epicondylitis: A Systematic Review. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221095565

[11] Medial Epicondyle Apophyseal Avulsion Fractures in Youth Throwers: A Severe Variant of Little League Elbow (132). Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967121s00275

[12] Medial Epicondyle Fracture With Concomitant Flexor-Pronator Mass Avulsion From the Fracture Fragment. JBJS Case Connector. 2020. DOI: 10.2106/jbjs.cc.19.00417

[13] Paper 38: Proximal Bony UCL Avulsion Fractures of the Pediatric Medial Epicondyle: Radiographic Union Rate and Early Clinical Outcomes. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00095

[14] Outcomes of Therapy and Ulnar Nerve Transposition for Elbow Stiffness After Pediatric Medial Epicondyle Fractures. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.07.002

[15] Poster 48: Fracture Patterns in Pediatric Humeral Medial Epicondyle: An MRI-Based Investigation. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00159

[16] Diagnosis and treatment of medial epicondylitis of the elbow. Clinics in Sports Medicine. 2004. DOI: 10.1016/j.csm.2004.04.011

[17] Mini-open Muscle Resection Procedure under Local Anesthesia for Lateral and Medial Epicondylitis. Clinics in Orthopedic Surgery. 2009. DOI: 10.4055/cios.2009.1.3.123

[18] Medial Epicondylectomy. Hand Clinics. 2007. DOI: 10.1016/j.hcl.2007.06.002

[19] A case of pediatric medial epicondyle fracture with medial and lateral collateral ligament injury. JSES International. 2024. DOI: 10.1016/j.jseint.2024.05.014

[20] Chronic incarceration of the medial epicondyle: a case report. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.09.030

[21] Medial Epicondylitis. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/JAAOS-D-14-00145

[22] A simple, safe and reliable surgical landmark for medial epicondylectomy. Shoulder & Elbow. 2014. DOI: 10.1177/1758573214526363

[23] Medial Epicondylitis in Occupational Settings: Prevalence, Incidence and Associated Risk Factors. Journal of Occupational and Environmental Medicine. 2003. DOI: 10.1097/01.jom.0000085888.37273.d9

[24] A rare case of elbow dislocation associated with unrecognized fracture of medial epicondyle and delayed ulnar neuropathy in pediatric age. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.11.009

[25] An extensive posterior approach of the elbow with osteotomy of the medial epicondyle. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.11.021

[26] Outcome of Partial Medial Epicondylectomy for Cubital Tunnel Syndrome. Clinical Orthopaedics & Related Research. 2006. DOI: 10.1097/01.blo.0000201153.36948.29

[27] Medial Epicondylar Apophyseal Avulsion Fractures in Youth Throwers: A Severe Variant of Little League Elbow. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671251365974

[28] Pediatric Medial Epicondyle Fracture Management: A Systematic Review. Journal of Pediatric Orthopaedics. 2020. DOI: 10.1097/bpo.0000000000001532

[29] Management of medial epicondyle nonunion with open reduction internal fixation and interposition distal clavicle autograft: a case report. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100671

[31] Treatment of fractures of the medial epicondyle of the humerus. Injury. 1988. DOI: 10.1016/0020-1383(88)90109-x

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[35] Poster 187: The Effect of Elbow Varus Torque on Medial Epicondyle in Little League Pitchers. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00748

[36] Influence of medial epicondyle morphology on the contribution of flexor–pronator muscle contractions to dynamic elbow stability. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100680

[37] Wide-awake surgery using local anaesthesia with adrenaline for ulnar nerve decompression and medial epicondylectomy. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241252518

[38] Operative versus non-operative management of pediatric medial epicondyle fractures: A systematic review. Journal of Children's Orthopaedics. 2009. DOI: 10.1007/s11832-009-0192-7

[39] The Influence of Pitch Velocity on Medial Elbow Pain and Medial Epicondyle Abnormality Among Youth Baseball Players. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520914911

[40] Lateral and medial epicondylitis: Role of occupational factors. Best Practice & Research Clinical Rheumatology. 2011. DOI: 10.1016/j.berh.2011.01.013

[42] Age-Specific Prevalence and Clinical Characteristics of Humeral Medial Epicondyle Apophysitis and Osteochondritis Dissecans: Ultrasonographic Assessment of 4249 Players. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117707703

[43] Arthroscopic Technique for Medial Epicondylitis: Technique and Safety Analysis. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2009.09.017

[44] Letter Regarding “Mapping Origins of Tendons on the Medial Epicondyle to Improve Treatment of Medial Epicondylitis: Anatomical Study”. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.09.021

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[46] Double-Row Repair for Recalcitrant Medial Epicondylitis. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119885608

[47] USE OF A WASHER DOES NOT AFFECT THE RATE OF IMPLANT REMOVAL OR ELBOW MOTION AFTER FIXATION OF MEDIAL EPICONDYLE FRACTURES. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00184

[49] Operative treatment of displaced medial epicondyle fractures in children and adolescents. Journal of Shoulder and Elbow Surgery. 2005. DOI: 10.1016/j.jse.2004.07.007

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