Simultaneous Open Surgical Release for Coexistent Lateral and Medial Epicondylitis in the Same Elbow: A Case Report

Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow) are common overuse tendinopathies of the elbow, yet simultaneous clinically relevant involvement of both epicondyles in the same elbow requiring surgery is rarely described. We report the case of a 49-year-old right-hand-dominant male patient with chronic right elbow pain for three years with no antecedent trauma. He had received four corticosteroid injections around the elbow with only transient improvement. Examination revealed localized tenderness over both the lateral and medial epicondyles with pain reproduced by resisted wrist extension and flexion (Cozen's and reverse Cozen's tests positive). Ultrasound demonstrated focal tendinosis of the deep fibers of the common flexor origin at the medial epicondyle and a focal partial tear with tendinosis of the common extensor origin at the lateral epicondyle. After failure of prolonged conservative management, the patient underwent open debridement and release of both the common extensor and common flexor origins in a single sitting with gentle epicondylar decortication. Histopathology confirmed tendinosis with collagen and hyaline degeneration, occasional fibroblasts, and focal neovascularity, consistent with a chronic angiofibroblastic tendinopathy. The postoperative course was uneventful, and a structured rehabilitation protocol was followed. The patient reported complete relief of pain and full return to activities of daily living without recurrence. This case illustrates the presentation of concomitant, clinically significant lateral and medial epicondylitis in a single elbow in a patient who had received repeated corticosteroid injections and had prolonged symptoms. In carefully selected patients with bilateral epicondylar involvement unresponsive to non-operative care, simultaneous open debridement and release of both the common extensor and common flexor origins can provide durable pain relief and functional recovery. Routine examination of both epicondyles and critical appraisal of repeated corticosteroid injections are important when managing chronic elbow pain.