Common Flexor Tendon Injection

Chronic tendinitis - 'golfer's elbow'

Causes and findings:
• Overuse
• Pain at medial aspect of elbow aggravated by gripping and lifting
• Painful: resisted flexion of wrist occasionally resisted pronation of forearm

Equipment:
Syringe - 1ml
Needle - 25G 0.5 inches (16mm) orange
Kenalog 40 - 10 mg
Lidocaine - 0.75 ml 2%
Total volume - 1 ml

Anatomy:
The common flexor tendon at the elbow arises from the anterior facet on the medial epicondyle. It is approximately the size of the little finger nail at its
teno-osseous origin.

Technique:
• Patient sits with supported arm extended
• Identify facet lying anteriorly on medial epicondyle
• Insert needle perpendicular to facet and touch bone
• Pepper solution into tendon

Aftercare:
Relative rest for 1 week, then stretching and strengthening exercises can be started.

Comments:
Occasionally the lesion occurs at the musculotendinous junction, which is invariably a very tender point. Infiltration at this point might not be as effective
but deep friction can be successful. This lesion is not as common as tennis elbow and less prone to recurrence, so follow-up treatment of deep friction and manipulation do not seem to be necessary.