Purpose: The purpose was to determine whether Z-lengthening approach for common flexor tendon debridement is a viable option for medial epicondylitis refractory to non-surgical treatment. Methods: A total of 12 patients (14 elbows) who underwent surgical debridement via Z-lengthening approach for management of medial epicondylitis between 1997 and 2009 met inclusion criteria. All patients failed conservative treatment. There were 4 men (4 elbows) and 8 women (10 elbows). Mean age: 55 ± 9. Two patients required ulnar nerve transposition for pre-operative symptoms. Results: At an average of 14.8 ± 4.7 months follow-up, post-operative satisfaction averaged 9.2 ± 0.77 out of 10. The Nirschl clinical assessment was rated as excellent in 30%, good in 50%, fair in 20%, and failure in 0%. McGowan grading system demonstrated: 11 of 14 elbows had no neuropathy (numbness/tingling/weakness/atrophy distal to the elbow), two had Grade I, and one had Grade II. Average visual analog scale pain score out of a possible 10 was 0.78 ± 1.5 at rest, 1.71 ± 1.72 with daily activities, and 2.85 ± 2.74 with sports. Average disability of the arm, shoulder, and hand: 37.73 ± 13.11. Conclusion: Patients with medial epicondylitis refractory to conservative management should be considered for surgical debridement via a Z-lengthening approach for debridement of the common flexor mass.