The Elbow

Previous to local treatment, a precise palpation of the common flexor tendon is necessary
in order to find the exact localisation of the lesion.

The patient lies on the couch with the upper arm abducted and externally rotated, the elbow
almost fully extended and in full supination.

The examiner sits or stands level with the patients head , supporting the elbow with his
ipsilateral hand. The medial epicondyle is now easily detected.

The individual tendons of the wrist flexors that form the common flexor tendon run in a distal direction.
Technique: Putting the pisiforme of the contralateral hand right on the medial epicondyle in such a way that the little fingers points in the direction of the head of the ulna and the middle finger in the direction of the styloid process of the radius, then :

little finger is on top of the flexor carpi ulnaris
ringfinger points in the direction of the palmaris longus,
middlefinger is level with the de flexor carpi radialis
and the index points towards the pronator teres.
The common flexor tendon (a lesion here is called Type I) can be felt on top of and just distal to the medial epicondyle. Soft pressure will reveal tough resistance of the tendon.
The individual tendons and their musculo-tendinous junctions (a lesion in one of these is called Type II) are felt about 1 to 2 cm cm distally to the epicondyle ( the border of the palpating finger being level with the distal edge of the epicondyle ). The tendons are felt as hard, fibrous structures running in a distal direction.

Treatment of a type I lesion (tenoperiosteal) is either one or two infiltrations with triamcinolone or deep transverse friction.

Golfer's elbow - Palpation