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Musculoskeletal
Diagnosis
Trauma
Elbow
Tendons
Common Flexor-Pronator Tendon Injury
Common Flexor-Pronator Tendon Injury
Donna G. Blankenbaker, MD, FACR; Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Flexor tendinopathy (preferred term), flexor tendinosis, medial epicondylitis, flexor tendinitis, golfer's elbow
                • Medial epicondylitis remains very common term for clinical condition; should not be radiology descriptor

              • Definitions

                • Acute or chronic injury to origin of common flexor tendon (CFT) at its attachment to medial humeral epicondyle
                • Pronator teres also originates here and can be injured
                • CFT often assumed to include pronator teres in common parlance
                • Common flexor group includes pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, flexor carpi ulnaris

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                Selected References

                                                1. Kheterpal AB et al: Overuse injuries of the elbow. Radiol Clin North Am. 57(5):931-42, 2019
                                                2. Kwapisz A et al: Platelet-rich plasma for elbow pathologies: a descriptive review of current literature. Curr Rev Musculoskelet Med. 11(4):598-606, 2018
                                                3. Tarpada SP et al: Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 15(1):107-10, 2018
                                                4. do Nascimento AT et al: Arthroscopic surgical treatment of medial epicondylitis. J Shoulder Elbow Surg. 26(12):2232-5, 2017
                                                5. Kwon BC et al: The fascial elevation and tendon origin resection technique for the treatment of chronic recalcitrant medial epicondylitis. Am J Sports Med. 42(7):1731-7, 2014
                                                6. Dewan AK et al: MRI of the elbow: techniques and spectrum of disease: AAOS exhibit selection. J Bone Joint Surg Am. 95(14):e99 1-13, 2013
                                                7. Konin GP et al: US of the elbow: indications, technique, normal anatomy, and pathologic conditions. Radiographics. 33(4):E125-47, 2013
                                                8. Wenzke DR: MR Imaging of the elbow in the injured athlete. Radiol Clin North Am. 51(2):195-213, 2013
                                                9. Peerbooms JC et al: Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 38(2):255-62, 2010
                                                10. Van Hofwegen C et al: Epicondylitis in the athlete's elbow. Clin Sports Med. 29(4):577-97, 2010
                                                11. Rajeev A et al: Lateral compartment cartilage changes and lateral elbow pain. Acta Orthop Belg. 75(1):37-40, 2009
                                                12. Rineer CA et al: Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg Am. 34(3):566-76, 2009
                                                13. Park GY et al: Diagnostic value of ultrasonography for clinical medial epicondylitis. Arch Phys Med Rehabil. 89(4):738-42, 2008
                                                14. Richard MJ et al: Traumatic valgus instability of the elbow: pathoanatomy and results of direct repair. J Bone Joint Surg Am. 90(11):2416-22, 2008
                                                15. Shahabpour M et al: The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. Eur J Radiol. 65(2):194-200, 2008
                                                16. Suresh SP et al: Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment? Br J Sports Med. 40(11):935-9; discussion 939, 2006
                                                17. Tuite MJ et al: Sports-related injuries of the elbow: an approach to MRI interpretation. Clin Sports Med. 25(3):387-408, v, 2006
                                                18. Banks KP et al: Overuse injuries of the upper extremity in the competitive athlete: magnetic resonance imaging findings associated with repetitive trauma. Curr Probl Diagn Radiol. 34(4):127-42, 2005
                                                19. Kijowski R et al: Magnetic resonance imaging findings in patients with medial epicondylitis. Skeletal Radiol. 34(4):196-202, 2005
                                                20. Kijowski R et al: Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol. 34(1):1-18, 2005
                                                21. Ciccotti MC et al: Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med. 23(4):693-705, xi, 2004
                                                22. Descatha A et al: Medial epicondylitis in occupational settings: prevalence, incidence and associated risk factors. J Occup Environ Med. 45(9):993-1001, 2003
                                                23. Martin CE et al: MR imaging of epicondylitis. Skeletal Radiol. 27(3):133-8, 1998
                                                24. Fritz RC et al: Magnetic resonance imaging of the musculoskeletal system: Part 3. The elbow. Clin Orthop Relat Res. (324):321-39, 1996
                                                Related Anatomy
                                                Loading...
                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Synonyms

                                                              • Flexor tendinopathy (preferred term), flexor tendinosis, medial epicondylitis, flexor tendinitis, golfer's elbow
                                                              • Medial epicondylitis remains very common term for clinical condition; should not be radiology descriptor

                                                            • Definitions

                                                              • Acute or chronic injury to origin of common flexor tendon (CFT) at its attachment to medial humeral epicondyle
                                                              • Pronator teres also originates here and can be injured
                                                              • CFT often assumed to include pronator teres in common parlance
                                                              • Common flexor group includes pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, flexor carpi ulnaris

                                                            IMAGING

                                                            • General Features

                                                              • Radiographic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Ultrasonographic Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Gross Pathologic & Surgical Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Image Interpretation Pearls

                                                                                            • Reporting Tips

                                                                                              Selected References

                                                                                              1. Kheterpal AB et al: Overuse injuries of the elbow. Radiol Clin North Am. 57(5):931-42, 2019
                                                                                              2. Kwapisz A et al: Platelet-rich plasma for elbow pathologies: a descriptive review of current literature. Curr Rev Musculoskelet Med. 11(4):598-606, 2018
                                                                                              3. Tarpada SP et al: Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 15(1):107-10, 2018
                                                                                              4. do Nascimento AT et al: Arthroscopic surgical treatment of medial epicondylitis. J Shoulder Elbow Surg. 26(12):2232-5, 2017
                                                                                              5. Kwon BC et al: The fascial elevation and tendon origin resection technique for the treatment of chronic recalcitrant medial epicondylitis. Am J Sports Med. 42(7):1731-7, 2014
                                                                                              6. Dewan AK et al: MRI of the elbow: techniques and spectrum of disease: AAOS exhibit selection. J Bone Joint Surg Am. 95(14):e99 1-13, 2013
                                                                                              7. Konin GP et al: US of the elbow: indications, technique, normal anatomy, and pathologic conditions. Radiographics. 33(4):E125-47, 2013
                                                                                              8. Wenzke DR: MR Imaging of the elbow in the injured athlete. Radiol Clin North Am. 51(2):195-213, 2013
                                                                                              9. Peerbooms JC et al: Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 38(2):255-62, 2010
                                                                                              10. Van Hofwegen C et al: Epicondylitis in the athlete's elbow. Clin Sports Med. 29(4):577-97, 2010
                                                                                              11. Rajeev A et al: Lateral compartment cartilage changes and lateral elbow pain. Acta Orthop Belg. 75(1):37-40, 2009
                                                                                              12. Rineer CA et al: Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg Am. 34(3):566-76, 2009
                                                                                              13. Park GY et al: Diagnostic value of ultrasonography for clinical medial epicondylitis. Arch Phys Med Rehabil. 89(4):738-42, 2008
                                                                                              14. Richard MJ et al: Traumatic valgus instability of the elbow: pathoanatomy and results of direct repair. J Bone Joint Surg Am. 90(11):2416-22, 2008
                                                                                              15. Shahabpour M et al: The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. Eur J Radiol. 65(2):194-200, 2008
                                                                                              16. Suresh SP et al: Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment? Br J Sports Med. 40(11):935-9; discussion 939, 2006
                                                                                              17. Tuite MJ et al: Sports-related injuries of the elbow: an approach to MRI interpretation. Clin Sports Med. 25(3):387-408, v, 2006
                                                                                              18. Banks KP et al: Overuse injuries of the upper extremity in the competitive athlete: magnetic resonance imaging findings associated with repetitive trauma. Curr Probl Diagn Radiol. 34(4):127-42, 2005
                                                                                              19. Kijowski R et al: Magnetic resonance imaging findings in patients with medial epicondylitis. Skeletal Radiol. 34(4):196-202, 2005
                                                                                              20. Kijowski R et al: Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol. 34(1):1-18, 2005
                                                                                              21. Ciccotti MC et al: Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med. 23(4):693-705, xi, 2004
                                                                                              22. Descatha A et al: Medial epicondylitis in occupational settings: prevalence, incidence and associated risk factors. J Occup Environ Med. 45(9):993-1001, 2003
                                                                                              23. Martin CE et al: MR imaging of epicondylitis. Skeletal Radiol. 27(3):133-8, 1998
                                                                                              24. Fritz RC et al: Magnetic resonance imaging of the musculoskeletal system: Part 3. The elbow. Clin Orthop Relat Res. (324):321-39, 1996