Lateral and medial epicondylitis in the overhead athlete

Abstract

The act of throwing produces significant stresses about the elbow joint and surrounding soft tissues, resulting in a sport-specific pattern of injury. Many elbow injuries and conditions that occur in throwing athletes result from accumulated microtrauma secondary to these stresses and the repetitive motion of throwing. Two common repetitive-motion-induced conditions are lateral epicondylitis and medial epicondylitis. Both conditions can be treated nonoperatively in most patients. Lateral epicondylitis involves injury to the extensor carpi radialis brevis tendon, and medial epicondylitis involves injury to the flexor carpi radialis or pronator teres muscles, or both, near their origins. In chronic injuries, tendon damage can range from microtears to tendon rupture. Damage to the extensor carpi radialis brevis tendon in lateral epicondylitis can be classified according to its arthroscopic appearance into 3 types: type I with an intact capsule, type II with linear tears of the undersurface of the tendon, and type III with complete tears of the overlying capsule. Arthroscopic treatment of chronic lateral epicondylitis is effective. Treatment involves debriding the diseased capsule, releasing the extensor carpi radialis brevis tendinous origin, and decorticating the lateral epicondyle. Medial epicondylitis is less common than lateral epicondylitis and rarely requires surgical intervention. Surgical treatment involves open excision of diseased tissue without release of the tendons from the medial epicondyle. © 2001 Elsevier Science Ltd. All rights reserved.