Golfer's Elbow Info In-depth Evidence

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• 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].
• 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 [2].
• Fluoroscopy evaluation of elbow joint instability during surgery is valuable for understanding pathology and assessing treatment effectiveness in pediatric medial epicondyle fractures with collateral ligament injuries [4].
• Surgical management is successful for adolescent athletes with medial epicondyle fractures who sustain significant trauma, have elbow laxity or instability, or have significant fracture fragment displacement [5].
• 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 levels of play, provided other elbow problems are excluded [9].
• Most pediatric patients with proximal bony UCL avulsion fractures of the medial epicondyle return to activities at about 3 months without surgery, demonstrating excellent elbow range of motion and Timmerman-Andrews's scores regardless of union or nonunion [12].
• Arthroscopic surgical treatment for medial epicondylitis provides good outcomes and is safe and effective [14].
• 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 [21].
• Success rates for medial epicondylectomy are between 72% and 94%, as confirmed by 12 studies [23].
• 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 [24].
• Distal medial epicondylectomy for cubital tunnel syndrome yields preliminary results comparable with other epicondylectomy techniques but with lower complication rates [28].
• Open reduction and internal fixation (ORIF) of displaced medial epicondyle fractures is a reliable and successful procedure in adolescent overhead athletes, with relatively low risk of major complications, reinjury, or reoperation [50].

Anatomy & Pathophysiology

Bony Anatomy and Fracture Patterns

• Medial epicondyle nonunion can cause valgus instability of the elbow [1].
• Pediatric medial epicondyle fractures may be associated with medial and lateral collateral ligament injuries [4].
• MRI-based investigations have identified specific fracture patterns in pediatric humeral medial epicondyle injuries [13].
• Fragmentation of the medial epicondyle may compromise medial elbow dynamic stability in adult baseball players [40].
• An osteotomy of the medial epicondyle allows for dislocation of the elbow joint and provides good exposure for procedures such as total elbow prosthesis placement [48].
• Displaced medial epicondyle fractures of the humerus are treated surgically, with stiffness being rare even with postoperative immobilization [26].

Ligamentous and Dynamic Stability

• The flexor-pronator mass dynamically stabilizes the elbow against valgus torque [32].
• Isometric forearm pronation reduces valgus stress–induced widening of the medial joint space and medial elbow pain in patients with medial ulnar collateral ligament (MUCL) insufficiency [39].
• Ultrasonographic assessment demonstrates that flexor-pronator muscles contribute to elbow valgus stability [47].
• Repetitive baseball pitching reduces elbow valgus stability, attributed to decreased flexor-pronator mass contractile function [43].
• Increased flexor carpi ulnaris (FCU) elasticity is a risk factor for medial elbow injury in young baseball players [46].
• Incorporating the pronator teres into contraction tasks significantly reduces the medial joint space, emphasizing its important role in elbow joint stability [34].
• The medial elbow joint space is significantly reduced under 60-N valgus stress plus 50% MVC compared to 60-N valgus stress alone [33].

Pathophysiology and Risk Factors

• High elbow varus torque increases the risk of medial elbow disorder in Little League pitchers [37].
• Pitch velocity is significantly associated with abnormality of the medial epicondyle and elbow pain among youth baseball players [49].
• Golf injuries of the hand and wrist are common and most are related to overuse, requiring understanding of golf swing kinematics for diagnosis and management [15].
• Accurate diagnosis of medial epicondylitis requires distinguishing it from other elbow conditions, with treatment guided by the specific pathologic stage of the tendon [6].
• The treatment rationale for medial epicondyle (ME) injuries is often predicated on restoring elbow biomechanics through anatomical restoration of the ulnar collateral ligament (UCL) [13].

Classification

• Valgus instability of the elbow can result from medial epicondyle nonunion [1].
• Medial epicondyle apophyseal avulsion fractures in youth throwers represent a severe variant of Little League elbow [3].
• Pediatric medial epicondyle fractures can be associated with medial and lateral collateral ligament injuries [4].
• Medial epicondyle fractures account for up to 20% of elbow fractures in the pediatric population [54].
• 60% of pediatric medial epicondyle fractures are associated with elbow dislocation [54].
• Elbow dislocations associated with medial epicondyle fractures with intra-articular entrapment can be difficult to diagnose in the acute phase [11].
• Medial elbow pain requires a broad differential diagnosis that includes ulnar nerve disorders, cervical radiculopathy, and ligament injuries [8].
• Accurate diagnosis of medial epicondylitis requires distinguishing it from other elbow conditions [6].
• Golf injuries of the hand and wrist are common and most are related to overuse [15].
• Proximal bony UCL avulsion fractures of the pediatric medial epicondyle are a distinct injury pattern [12].
• Fracture patterns in pediatric humeral medial epicondyle injuries can be identified via MRI [13].

Clinical Presentation

• A large majority of patients with medial epicondyle apophyseal avulsion fractures in youth throwers reported medial elbow pain prior to the fracture [3].
• Evaluation of elbow joint instability using fluoroscopy during surgery is valuable for understanding pathology and assessing treatment effectiveness in cases of pediatric medial epicondyle fracture with collateral ligament injury [4].
• Surgical management is indicated for athletes with medial epicondyle fractures who sustain significant trauma, have elbow laxity or instability, or have significant fracture fragment displacement [5].
• Treatment of medial epicondylitis is guided by the specific pathologic stage of the tendon [6].
• 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].
• Medial elbow pain is uncommon and requires a broad differential diagnosis that includes ulnar nerve disorders, cervical radiculopathy, and ligament injuries [8].
• Arthroscopic treatment of posterolateral elbow impingement from lateral synovial plicae is highly successful in throwing athletes and golfers when other elbow problems are excluded [9].
• Patients with medial epicondyle fracture and concomitant flexor-pronator mass avulsion can achieve pain-free status, symmetric range of motion, elbow stability, and function compared to the contralateral extremity at 1-year follow-up [10].
• Elbow dislocations associated with medial epicondyle fractures with intra-articular entrapment can be difficult to diagnose in the acute phase, requiring a high level of suspicion [11].
• Identification of fracture patterns in pediatric humeral medial epicondyle injuries is a key step in understanding variability in clinical outcomes for medial elbow injuries [13].
• Understanding the kinematics of the golf swing is essential for diagnosis and management of hand and wrist injuries in golfers [15].
• Medial elbow pain during the return-to-throwing period after ulnar collateral ligament reconstruction is not uncommon, with up to half of pitchers potentially experiencing pain [17].
• A combined approach with ultrasound and MR arthrography shows higher accuracy than each modality alone for the assessment of medial elbow pain in baseball players [18].
• Mini-open muscle resection procedure under local anesthesia successfully manages medial or lateral epicondylitis unresponsive to long-term conservative treatments in 97.6% of cases [19].
• The prognosis for medial epicondylitis in occupational settings is good, with a 3-year recovery rate of 81% [20].
• 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 [22].
• Posterior shoulder instability with secondary impingement is a possible cause of shoulder pain in elite golfers [36].

Investigations

• Treatment for medial epicondylitis is guided by the specific pathologic stage of the tendon [6].
• A combined approach using ultrasonography (US) and MR arthrography shows higher accuracy than either modality alone for assessing medial elbow pain [18].
• Ultrasonography is recommended as an initial imaging method for the diagnosis of clinical medial epicondylitis [55].
• Ultrasonography provides good positive predictive value for medial epicondyle lesions among adolescent baseball players [56].
• Magnetic resonance imaging (MRI) findings may help distinguish between patients with medial epicondylitis and those with asymptomatic senescent changes of the common flexor tendon [58].
• There is substantial variation in imaging practices across the United States when diagnosing a medial epicondyle fracture [51].
• CT scans are more likely to be used for diagnosing medial epicondyle fractures in smaller cities and in older children [51].
• MRI is more likely to be used for diagnosing medial epicondyle fractures in smaller hospitals and in younger children [51].
• Evaluation of elbow joint instability using fluoroscopy during surgery is valuable for understanding the pathology and assessing treatment effectiveness [4].
• Elbow dislocations associated with fractures of the medial epicondyle with intra-articular entrapment can be difficult to diagnose in the acute phase, requiring a high level of suspicion [11].

Treatment

Non-Operative Management

• Percutaneous common flexor origin release of the medial humeral epicondyle provides significant and sustainable improvements in pain and function during a 1-year follow-up period [2].
• Nonoperative treatment may be appropriate for minimally displaced pediatric medial epicondyle apophyseal avulsion fractures [53].

Operative Management

• Surgical management is successful in adolescent athletes with medial epicondyle fractures who sustain significant trauma, have elbow laxity or instability, or have significant fracture fragment displacement [5].
• Arthroscopic debridement and focused rehabilitation are highly successful in treating posterolateral elbow impingement from lateral synovial plicae in throwing athletes and golfers, allowing return to previous levels of play [9].
• Arthroscopic surgical treatment for medial epicondylitis is safe, effective, and provides good outcomes [14].
• At an average of 6.3 years after surgery, clinical outcomes for operatively treated pediatric and adolescent medial epicondyle fractures are excellent [16].
• Mini-open muscle resection under local anesthesia successfully manages medial or lateral epicondylitis unresponsive to long-term conservative treatments, with 97.6% of elbows (41 of 42) managed successfully [19].
• Medial epicondylectomy has confirmed success rates between 72% and 94% across 12 studies [23].
• Surgical intervention for refractory medial epicondylitis often has a high success rate, with patients demonstrating improved patient-reported outcomes and an encouraging number returning to work with limited complications [24].
• Operative treatment of recalcitrant medial epicondylitis is effective in restoring patient function and strength [35].
• Operative treatment affords a significantly higher union rate compared to non-operative management of medial epicondyle fractures [41].
• Open and arthroscopic techniques are very effective and comparable for treating chronic medial epicondylitis [44].
• Partial medial epicondylectomy achieves good postoperative objective results in cubital tunnel syndrome [45].
• Distal medial epicondylectomy, a modification of partial medial epicondylectomy for cubital tunnel syndrome, yields preliminary results comparable to other epicondylectomy techniques with lower complication rates [28].
• The outcome of non-operative treatment for medial epicondyle fractures is usually satisfactory, as even fibrous union is compatible with excellent function [52].

Diagnostic Considerations in Treatment Planning

• Accurate diagnosis of medial epicondylitis requires distinguishing it from other elbow conditions, and treatment is guided by the specific pathologic stage of the tendon [6].
• Medial elbow pain requires a broad differential diagnosis including ulnar nerve disorders, cervical radiculopathy, and ligament injuries [8].
• Evaluation of elbow joint instability using fluoroscopy during surgery is valuable for understanding pathology and assessing treatment effectiveness in pediatric medial epicondyle fractures with collateral ligament injury [4].
• A large majority of patients with medial epicondyle apophyseal avulsion fractures in youth throwers reported medial elbow pain prior to fracture, suggesting this severe presentation of Little League elbow may be preventable [3].
• 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 [27].

Complications

• Medial epicondyle apophyseal avulsion fractures in youth throwers are a severe variant of Little League elbow [3].
• A large majority of patients with medial epicondyle apophyseal avulsion fractures reported medial elbow pain prior to the fracture [3].
• Bone union of medial epicondylar fragmentation is associated with a decreased prevalence of elbow pain at 1 year after initial presentation in young baseball players [7].
• Medial epicondyle fracture with concomitant flexor-pronator mass avulsion from the fracture fragment is a documented complication pattern [10].
• Most patients with proximal bony UCL avulsion fractures of the pediatric medial epicondyle return to activities at about 3 months without surgery, regardless of union or nonunion [12].
• Medial elbow pain during the return-to-throwing period after ulnar collateral ligament reconstruction (UCLR) is not uncommon, with up to half of pitchers potentially experiencing pain [17].
• There was no ulnar nerve palsy, no ulnar nerve subluxation, or medial elbow instability following partial medial epicondylectomy for cubital tunnel syndrome [25].
• 45% of patients reported mild pain at the 6-month follow-up after partial medial epicondylectomy for cubital tunnel syndrome [25].
• Stiffness is rare even with postoperative immobilization of the elbow (mean of 4 weeks) following surgical treatment of displaced medial epicondyle fractures [26].
• 73.3% of professional pitchers with a history of UCLR were able to return to sport after open reduction internal fixation (ORIF) of the medial epicondyle [29, 31].
• Only 55% of professional pitchers with a history of UCLR returned to sport at the same level or higher after ORIF of the medial epicondyle [29, 31].
• Chronic medial epicondyle apophysitis treatment involves rest and education, with no long-term complications reported [38].
• Heavy smoking, elbow flexion contracture, and preoperative disease severity are associated with persistently increased disability after minimal medial epicondylectomy for cubital tunnel syndrome [42].
• Modified oblique medial epicondylectomy for cubital tunnel syndrome minimizes complications previously associated with the original technique [57].
• Conservative treatment without prohibiting tennis play resulted in an 83% rate of spontaneous bone union for medial epicondylar fragmentation in male junior tennis players [30].
• Elbow pain persisted in 50% of subjects with medial epicondylar fragmentation at re-examination despite conservative treatment [30].

Recovery

• Fragment excision and ligament repair for valgus instability due to medial epicondyle nonunion is associated with rapid restoration of elbow stability [1].
• Fragment excision and ligament repair for valgus instability due to medial epicondyle nonunion is associated with minimal surgical morbidity [1].
• Fragment excision and ligament repair for valgus instability due to medial epicondyle nonunion is associated with a high rate of patient satisfaction [1].
• Fragment excision and ligament repair for valgus instability due to medial epicondyle nonunion is associated with an improvement in objective elbow scores [1].
• Percutaneous common flexor origin release of the medial humeral epicondyle for golfer's elbow provides significant and sustainable improvements in pain and function during a 1-year follow-up period [2].
• Percutaneous common flexor origin release of the medial humeral epicondyle for golfer's elbow is a safe and effective treatment option [2].
• Patients with medial epicondyle fracture and concomitant flexor-pronator mass avulsion were pain free at 1-year follow-up [10].
• Patients with medial epicondyle fracture and concomitant flexor-pronator mass avulsion had symmetric range of motion, elbow stability, and function compared with the contralateral extremity at 1-year follow-up [10].
• Most patients with proximal bony UCL avulsion fractures of the pediatric medial epicondyle return to activities at about 3 months without surgery [12].
• Patients with proximal bony UCL avulsion fractures of the pediatric medial epicondyle have excellent elbow range of motion and Timmerman-Andrews's score at return to activity, regardless of union or nonunion [12].
• Clinical outcomes for operatively treated medial epicondyle fractures in pediatric and adolescent patients are excellent at an average of 6.3 years after surgery [16].
• Up to half of pitchers experience medial elbow pain during the return-to-throwing period after ulnar collateral ligament reconstruction (UCLR) [17].
• 97.6% (41 out of 42) of elbows with medial or lateral epicondylitis unresponsive to long-term conservative treatments were managed successfully with mini-open muscle resection under local anesthesia [19].
• Posterior oblique medial epicondylectomy for cubital tunnel syndrome may preserve elbow stability and enable early active range of motion during the postoperative period [21].
• Partial medial epicondylectomy for cubital tunnel syndrome results in no ulnar nerve palsy, no ulnar nerve subluxation, or medial elbow instability [25].
• 45% of patients reported mild pain at 6-month follow-up after partial medial epicondylectomy for cubital tunnel syndrome [25].
• Return to sport after ORIF of the medial epicondyle in professional pitchers with a history of UCLR occurs without a significant decline in most performance variables compared with preoperative performance or matched controls [29].
• 73.3% of professional pitchers with a history of UCLR were able to return to sport following medial epicondyle ORIF [31].
• Return to sport following medial epicondyle ORIF in professional pitchers with a history of UCLR occurs without a significant decline in most performance variables compared to pre-operative performance levels or matched controls [31].
• Conservative treatment without prohibiting tennis play for medial epicondylar fragmentation in male junior tennis players resulted in an 83% rate of spontaneous bone union [30].

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] 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. [2] (10.1016/j.rboe.2016.06.007)
• [L3] A large majority of patients reported medial elbow pain prior to fracture, suggesting this severe presentation of Little League elbow may be preventable. [3] (10.1177/2325967121s00275)
• [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. [4] (10.1016/j.jseint.2024.05.014)
• [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. [5] (10.1177/0363546513480797)
• [L5] Accurate diagnosis requires distinguishing it from other elbow conditions, and treatment is guided by the specific pathologic stage of the tendon. [6] (10.1016/j.csm.2004.04.011)
• [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)
• [L5] Medial elbow pain is uncommon and requires a broad differential diagnosis including ulnar nerve disorders, cervical radiculopathy, and ligament injuries. [8] (10.1302/2058-5241.2.160006)
• [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)
• [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. [10] (10.2106/jbjs.cc.19.00417)
• [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. [11] (10.1016/j.jse.2012.11.009)
• [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. [12] (10.1177/2325967125s00095)
• [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. [13] (10.1177/2325967125s00159)
• [L4] Arthroscopic surgical treatment for medial epicondylitis of the elbow provides good outcomes and is safe and effective. [14] (10.1016/j.jse.2017.08.019)
• [L5] Golf injuries of the hand and wrist are common and most are related to overuse; understanding the kinematics of the golf swing is essential for diagnosis and management. [15] (10.1016/j.hcl.2016.08.012)
• [L4] At an average of 6.3 years after surgery, the clinical outcomes for medial epicondyle fracture were excellent. [16] (10.1016/j.jhsg.2021.02.006)
• [L3] Medial elbow pain during the return-to-throwing period after UCLR is not uncommon, with up to half of pitchers potentially experiencing pain. [17] (10.1177/2325967118808782)
• [L2] The combined approach with both MR arthrography and US shows higher accuracy than each modality alone for the assessment of medial elbow pain. [18] (10.1148/radiol.2015151256)
• [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. [19] (10.4055/cios.2009.1.3.123)
• [L2] The prognosis for medial epicondylitis in this population was good with a 3-year recovery rate at 81%. [20] (10.1097/01.jom.0000085888.37273.d9)
• [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. [21] (10.1016/j.jhsg.2025.100809)
• [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. [22] (10.1016/j.jse.2011.09.030)
• [L5] The article outlines indications and a technique for medial epicondylectomy, noting that 12 studies have confirmed success rates between 72% and 94%. [23] (10.1016/j.hcl.2007.06.002)
• [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. [24] (10.1177/03635465221095565)
• [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. [25] (10.1097/01.blo.0000201153.36948.29)
• [L4] Even with postoperative immobilization of the elbow (mean of 4 weeks), stiffness is rare. [26] (10.1007/s00402-009-1009-3)
• [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. [27] (10.1097/bpo.0000000000001532)
• [L4] The preliminary results are comparable with other epicondylectomy techniques with lower complication rates. [28] (10.1007/s00402-012-1599-z)
• [L4] After ORIF of the medial epicondyle in professional pitchers with a history of UCLR, 73.3% were able to return to sport (only 55% at the same level or higher) without a significant decline in most performance variables when compared with their preoperative performance or matched controls. [29] (10.1177/2325967119852896)
• [L2] Although conservative treatment without prohibiting tennis play resulted in an 83% rate of spontaneous bone union, elbow pain persisted in 50% of subjects at re-examination. [30] (10.1016/j.jse.2014.06.044)
• [L4] Following medial epicondyle ORIF of professional pitchers with a history of UCLR, 73.3% were able to RTS without a significant decline in most performance variables when compared to their pre-operative performance levels, or when compared to matched controls. [31] (10.1016/j.jse.2020.01.038)
• [L5] The flexor-pronator mass dynamically stabilizes the elbow against valgus torque. [32] (10.2106/00004623-200410000-00020)
• [L5] The medial elbow joint space was significantly reduced under 60-N valgus stress plus 50% MVC compared to 60-N valgus stress alone. [33] (10.1016/j.jse.2022.03.027)
• [L4] Incorporating the pronator teres into contraction tasks significantly reduced the medial joint space, emphasizing the important role of the PT in elbow joint stability. [34] (10.1016/j.jse.2024.12.025)
• [L4] Operative treatment of recalcitrant medial epicondylitis is effective in restoring patient function and strength. [35] (10.1308/003588413x13629960048479)
• [L4] Clinicians should be aware of posterior shoulder instability and the associated secondary diagnosis of rotator cuff impingement as a possible cause of shoulder pain in elite golfers. [36] (10.1177/03635465020300062101)
• [L3] High elbow varus torque would increase the risk of medial elbow disorder. [37] (10.1177/2325967121s00748)
• [L4] Isometric forearm pronation reduces valgus stress–induced widening of the medial joint space and medial elbow pain in patients with MUCL insufficiency. [39] (10.1016/j.jse.2021.10.015)
• [L2] Fragmentation of the medial epicondyle may contribute to compromised medial elbow dynamic stability in adult baseball players. [40] (10.1016/j.xrrt.2026.100680)
• [L4] Operative treatment affords a significantly higher union rate over the non-operative management of medial epicondyle fractures. [41] (10.1007/s11832-009-0192-7)
• [L4] Heavy smoking, elbow flexion contracture, and preoperative disease severity are associated with persistently increased disability after minimal medial epicondylectomy for CuTS. [42] (10.1016/j.bjps.2018.05.038)
• [L5] Repetitive baseball pitching reduced elbow valgus stability, attributed to decreased flexor-pronator mass contractile function. [43] (10.1016/j.jse.2023.03.026)
• [L3] Open and arthroscopic techniques were very effective and comparable for treating chronic medial epicondylitis. [44] (10.1016/j.jse.2022.09.018)
• [L4] Good postoperative objective results were reached by partial medial epicondylectomy. [45] (10.1007/s00402-010-1160-x)
• [L2] Increased flexor carpi ulnaris (FCU) elasticity is a risk factor for medial elbow injury. [46] (10.1177/03635465231202028)
• [L4] Ultrasonographic assessment demonstrated that flexor-pronator muscles contribute to elbow valgus stability. [47] (10.1016/j.jses.2019.10.003)
• [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. [48] (10.1016/j.jse.2013.11.021)
• [L3] Pitch velocity was significantly associated with abnormality of the medial epicondyle and elbow pain. [49] (10.1177/0363546520914911)
• [L4] ORIF of displaced medial epicondyle fractures is a reliable and successful procedure in adolescent overhead athletes with high demands, with relatively low risk of major complications, reinjury, or reoperation. [50] (10.1177/2325967120976573)
• [L3] There is substantial variation in imaging practices across the United States when diagnosing a medial epicondyle fracture, with CT scans more likely in smaller cities and older children, and MRI more likely in smaller hospitals and younger children. [51] (10.1177/2325967119s00071)
• [L4] The outcome of non-operative treatment is usually satisfactory as even a fibrous union is compatible with excellent function. [52] (10.1016/0020-1383(88)90109-x)
• [L4] Nonoperative treatment may be appropriate for minimally displaced cases. [53] (10.1177/23259671251365974)
• [L5] Medial epicondyle fractures account for up to 20% of elbow fractures in the pediatric population, with 60% associated with elbow dislocation. [54] (10.5435/jaaos-20-04-223)
• [L2] Therefore, ultrasonography is recommended as an initial imaging method for the diagnosis of clinical medial epicondylitis. [55] (10.1016/j.apmr.2007.09.048)
• [L4] Ultrasonography provides good positive predictive value for medial epicondyle lesions, and decreased shoulder external rotation may relate to these lesions. [56] (10.1007/s00167-018-5178-x)
• [L4] This medial collateral ligament sparing technique minimized complications previously associated with the original technique. [57] (10.1016/j.jhsa.2012.11.006)
• [L4] These MR imaging findings may be helpful to distinguish between patients with medial epicondylitis and patients with asymptomatic senescent changes of the common flexor tendon. [58] (10.1007/s00256-005-0896-9)

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] 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

[3] 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

[4] 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

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

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

[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] Medial elbow pain. EFORT Open Reviews. 2017. DOI: 10.1302/2058-5241.2.160006

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

[11] 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

[12] 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

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

[14] Arthroscopic surgical treatment of medial epicondylitis. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.08.019

[15] Hand and Wrist Injuries in Golfers and Their Treatment. Hand Clinics. 2017. DOI: 10.1016/j.hcl.2016.08.012

[16] Long-Term Outcomes of Operatively Treated Medial Epicondyle Fractures in Pediatric and Adolescent Patients. Journal of Hand Surgery Global Online. 2021. DOI: 10.1016/j.jhsg.2021.02.006

[17] Medial Elbow Pain During the Return-to-Throwing Period After Ulnar Collateral Ligament Reconstruction in Pitchers. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118808782

[18] Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball Players. Radiology. 2016. DOI: 10.1148/radiol.2015151256

[19] 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

[20] 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

[21] 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

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

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

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

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

[26] 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

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

[28] Distal medial epicondylectomy. A modification of partial medial epicondylectomy for cubital tunnel syndrome: preliminary results. Archives of Orthopaedic and Trauma Surgery. 2012. DOI: 10.1007/s00402-012-1599-z

[29] Open Reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119852896

[30] Characteristics and prognosis of medial epicondylar fragmentation of the humerus in male junior tennis players. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.06.044

[31] Open Reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.038

[32] Dynamic Contributions of the Flexor-Pronator Mass to Elbow Valgus Stability. The Journal of Bone & Joint Surgery. 2004. DOI: 10.2106/00004623-200410000-00020

[33] Changes in medial elbow joint space with differences in contraction strength of flexor-pronator muscle under elbow valgus stress. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.03.027

[34] Influence of flexor pronator muscle contraction on medial elbow joint space distance in high school baseball players: a cross-sectional study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.025

[35] Operative treatment improves patient function in recalcitrant medial epicondylitis. The Annals of The Royal College of Surgeons of England. 2013. DOI: 10.1308/003588413x13629960048479

[36] Posterior Instability of the Shoulder with Secondary Impingement in Elite Golfers. The American Journal of Sports Medicine. 2002. DOI: 10.1177/03635465020300062101

[37] 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

[38] Open Reduction and Internal Fixation for Displaced or Entrapped Medial Epicondyle. 2020.

[39] The role of the flexor pronator muscles as dynamic stabilizers against elbow valgus stress in patients with medial ulnar collateral ligament insufficiency. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.10.015

[40] 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

[41] 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

[42] Clinical features affecting the patient-based outcome after minimal medial epicondylectomy for cubital tunnel syndrome. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2018. DOI: 10.1016/j.bjps.2018.05.038

[43] Repetitive pitching decreases the elbow valgus stability provided by the flexor-pronator mass: the effects of repetitive pitching on elbow valgus stability. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.03.026

[44] Open procedure vs. arthroscopic débridement for chronic medial epicondylitis. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.09.018

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

[46] Elasticity of the Forearm Flexor-Pronator Muscles as a Risk Factor for Medial Elbow Injuries in Young Baseball Players: A Prospective Cohort Study of 314 Players. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231202028

[47] Flexor pronator muscles' contribution to elbow joint valgus stability: ultrasonographic analysis in high school pitchers with and without symptoms. JSES International. 2020. DOI: 10.1016/j.jses.2019.10.003

[48] 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

[49] 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

[50] Clinical Outcomes and Return to Play in Youth Overhead Athletes After Medial Epicondyle Fractures Treated With Open Reduction and Internal Fixation. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967120976573

[51] HOW DO IMAGING PRACTICES VARY ACROSS THE UNITED STATES WHEN DIAGNOSING A MEDIAL EPICONDYLE FRACTURE?. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00071

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

[53] 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

[54] Medial Epicondyle Fractures in the Pediatric Population. Journal of the American Academy of Orthopaedic Surgeons. 2012. DOI: 10.5435/jaaos-20-04-223

[55] Diagnostic Value of Ultrasonography for Clinical Medial Epicondylitis. Archives of Physical Medicine and Rehabilitation. 2008. DOI: 10.1016/j.apmr.2007.09.048

[56] Ultrasonography has high positive predictive value for medial epicondyle lesions among adolescent baseball players. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5178-x

[57] Outcomes Following Modified Oblique Medial Epicondylectomy for Treatment of Cubital Tunnel Syndrome. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.11.006

[58] Magnetic resonance imaging findings in patients with medial epicondylitis. Skeletal Radiology. 2005. DOI: 10.1007/s00256-005-0896-9