Disorders of the Elbow: Medial

Common Flexor Origin Enthesopathy

Tendinopathy of the common flexor origin (CFO) is less common than its extensor counterpart. The presenting features are similar, although the sporting and occupational associations are different. There is a particular sporting association with golf and the term golfer's elbow has come into common use. Other names, such as medial tennis elbow and flexor–pronator sprain, are also applied.

Pain is worse on resisted flexion, as opposed to extension with common extensor origin (CEO) tendinopathy.

The ultrasound findings are similar to CEO tendinopathy. As has been previously discussed, the configuration of CFO is different from that on the extensor side.

This more general hyporeflectivity must not be misinterpreted as tendinopathy. Signs of tendinopathy include loss of the normal fibrillar structure of the true tendinous portion of the CFO. Increased Doppler is a common and useful sign to draw attention to the diseased area. More advanced signs include tendon delamination leading to partial tears and ultimately tendon separation from the epiphysis ( Fig. 7.2 ). Acute changes, particularly due to trauma, may also involve the pronator teres muscle. Chronic changes include calcification and bony irregularity representing enthesopathy at the attachment.

This is because the floor of the cubital tunnel receives some fibres from the dorsal aspect of the CFO and consequently tendinopathy of the CFO may also irritate the overlying ulnar nerve. As symptoms may be difficult to differentiate on clinical grounds, an assessment of both of these structures should be carried out in patients presenting with medial elbow pain. The differential diagnosis also includes injuries to the ulnar collateral ligament (UCL), median neuropathy and pronator teres.