Medial Epicondylitis Release: Open debridement of the common flexor-pronator mass

Q1. What is a medial epicondylitis release?

Medial epicondylitis release is a surgical procedure designed to treat severe, chronic golfer's elbow (medial epicondylitis) that has not responded to non-surgical treatments. The surgery involves removing damaged tendon tissue (debridement) at the inner side of the elbow to relieve pain and promote healthy tissue healing.

Q2. Why is this surgery recommended for golfer's elbow?

While most cases of golfer's elbow heal with rest, physical therapy, or injections, some patients continue to experience severe pain and limited function. Surgery is recommended when:

• Pain persists for more than 6 to 12 months despite active conservative care.
• The pain significantly interferes with daily activities, work, or sleep.
• Diagnostic tests, like an MRI or ultrasound, confirm significant tissue damage or tearing in the tendons.

Q3. What is the "common flexor-pronator mass" and why does it need debridement?

The common flexor-pronator mass is a group of tendons that attach to the bony bump on the inner side of your elbow (the medial epicondyle). These muscles allow you to flex your wrist and pronate (rotate) your forearm. Chronic repetitive stress can cause micro-tearing and degenerative changes (tendinosis) in these tendons. Debridement means carefully cleaning away and removing this worn-out, scarred, and diseased tissue so that the remaining healthy tendon can heal properly.

Q4. What are the signs that I might need this surgery?

You might be a candidate for surgery if you experience:

• Persistent pain and tenderness on the inner bump of your elbow.
• Stiffness in the elbow joint or weakness when gripping objects or turning your wrist.
• Numbness or tingling radiating down into your ring and pinky fingers (which can happen if the nearby ulnar nerve is irritated).
• No lasting improvement after trials of rest, bracing, physical therapy, or injections.

Q5. How should I prepare for my medial epicondylitis release surgery?

Preparing for surgery involves several key steps to ensure a safe procedure and smooth recovery:

• Review your current medications with Dr. Veillette's team; you may need to stop blood thinners or anti-inflammatory drugs a week before surgery.
• Arrange for a family member or friend to drive you home after the procedure and stay with you for the first 24 hours.
• Prepare your home by placing frequently used items within easy reach of your non-operated arm.
• Follow the fasting instructions (no food or drink) provided by the hospital or surgical center for the night before your procedure.

Q6. What type of anesthesia is used during the procedure?

Medial epicondylitis release is typically performed on an outpatient basis using a combination of regional anesthesia and sedation. A regional nerve block is often used to numb your entire arm, which provides excellent pain relief during and immediately after the surgery. You will also receive light sedation to keep you relaxed and comfortable throughout the procedure.

Q7. How is the surgery performed (open debridement)?

During an open medial epicondylitis release, the surgeon makes a small incision (usually 3 to 5 centimeters) over the inner side of your elbow. The surgeon then:

• Carefully exposes the common flexor-pronator tendon mass.
• Identifies and cuts away the damaged, scarred, and degenerated tendon tissue.
• Inspects the nearby ulnar nerve to ensure it is not compressed or irritated. If it is compressed, a release of the nerve (ulnar nerve transposition or decompression) may be performed at the same time.
• Reattaches the healthy tendon back to the bone using sutures or small bone anchors.
• Closes the skin incision with stitches and applies a sterile dressing.

Q8. Will I need to stay in the hospital after the procedure?

No, this surgery is almost always performed as an outpatient (same-day) procedure. You will spend a few hours in the recovery room while the anesthesia wears off. Once you are comfortable, can tolerate fluids, and meet the discharge criteria, you will be allowed to go home to continue your recovery.

Q9. Will I need to wear a splint or brace after surgery, and for how long?

Yes, your elbow will initially be placed in a soft splint or a lightweight plaster splint at a 90-degree angle to protect the repaired tendons. You will typically wear this splint for the first 7 to 10 days. During this time, you should keep the splint clean and dry. Dr. Veillette will transition you to a removable brace or support at your first post-operative visit, allowing you to begin gentle, guided range-of-motion exercises.

Q10. How can I manage pain and swelling immediately after the operation?

Managing pain and swelling is crucial for a comfortable recovery:

• Keep your arm elevated above the level of your heart as much as possible for the first 48 to 72 hours to reduce swelling.
• Apply ice packs wrapped in a thin towel to your elbow for 15 to 20 minutes every few hours, making sure to keep the splint dry.
• Take your prescribed pain medications exactly as directed by your healthcare team, and transition to over-the-counter pain relievers as your pain decreases.
• Gently wiggle your fingers and move your shoulder frequently to keep circulation flowing and prevent stiffness.

Q11. What is the best way to sleep comfortably after elbow surgery?

Sleeping can be challenging during the first couple of weeks. Many patients find these positions helpful:

• Sleeping in a recliner chair or propped up with several pillows in bed.
• Placing a pillow under your operated arm to keep it elevated and prevent it from rolling or stretching awkwardly during the night.
• Avoiding sleeping directly on your operated side.

Q12. When can I return to normal daily activities and work?

Your return timeline depends on the physical demands of your daily routine or job:

• Light daily tasks (like typing or eating) using your non-operated hand can begin within a few days. You can start using your operated arm for very light tasks once the splint is removed (about 1 to 2 weeks post-op).
• Sedentary or desk jobs can often be resumed within 1 to 2 weeks.
• Jobs involving light lifting or repetitive arm movements may require 6 to 8 weeks.
• Heavy manual labor, heavy lifting, or sports requiring strong grip and forearm usage may require 3 to 4 months of recovery.

Q13. What does the rehabilitation and physical therapy process look like?

Physical therapy is a key component of your recovery to restore strength and flexibility:

• Phase 1 (Weeks 1-2): Protect the tendon, control swelling, and practice gentle finger and shoulder movements.
• Phase 2 (Weeks 2-6): Begin active-assisted and active elbow and wrist range-of-motion exercises. The goal is to fully restore mobility.
• Phase 3 (Weeks 6-12): Introduce progressive strengthening exercises for the wrist flexors, forearm pronators, and shoulder muscles.
• Phase 4 (Month 3 and beyond): Transition to sports-specific or work-specific training to safely return to full activities.

Q14. What are the main risks and potential complications of this surgery?

Medial epicondylitis release is a very safe procedure, but like any surgery, it carries some risks. These include:

• Infection at the incision site.
• Temporary or permanent numbness, tingling, or weakness due to irritation of the ulnar nerve.
• Persistent pain or recurrence of golfer's elbow symptoms.
• Stiffness or loss of full elbow extension.
• Delayed healing of the tendon or incision.

Q15. What are the long-term success rates and expected outcomes of the procedure?

The long-term success rate for medial epicondylitis release is excellent, with 85% to 90% of patients experiencing significant pain relief and improved elbow function. Most patients are able to return to their favorite sports, recreational activities, and work tasks without the chronic pain they experienced before surgery. Full recovery and maximum improvement typically occur between 4 to 6 months after the procedure.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.