Medial epicondylitis, often called golfer’s elbow, results from the pathologic combination of intrinsic muscle contraction of the flexor-pronator muscles added to the extrinsic valgus force of swinging or throwing. Much like lateral epicondylitis, this condition is not limited to the athletic population but is also associated with many occupations in which repetitive wrist flexion and pronation are required, such as carpentry.
Signs & Symptoms
- Patients who have medial epicondylitis tend to report a gradual onset and increase of medial symptoms without a particular inciting event.
- Pain is usually noted during the acceleration phase of throwing when the Flexor Carpi Radialis and Pronator Teres are most active.
- Pain localizes to either the medial epicondyle or just distal in the flexor-pronator mass.
A differential diagnosis generated from the history guides the physical examination. The differential for medial elbow pain includes:
- Medial epicondylitis
- Ulnar neuritis
- Ulnar collateral ligament attenuation with resultant instability
- Flexor pronator muscle belly ruptures.
- Depending on the patient’s age, Little League elbow, or physeal fracture of the medial epicondyle, can also be suspected.
- Older athletes tend to have insidious onset of symptoms unless there is an acute muscle belly rupture.
(Research is inconclusive for statistical data of these tests)
- Treatment of medial epicondylar pathology depends much on the age of the patient and his or her particular circumstances.
- The protocol of rest, ice, and nonsteroidal antiinflammatory medication is believed to be useful for relief of epicondylitis symptoms in about 90% of patients.
- Nonsurgical treatment is usually successful and remains the mainstay of treatment.
- Surgical treatment of medial epicondylitis is reserved for those patients who do not show significant improvement with rest and a supervised course of prolonged rehabilitation; a period of 6 to 12 months has been recommended.
Nonoperative treatment is divided into 3 different phases:
- Immediate and complete cessation of the offending activity, which is not to be confused with complete immobilization.
- The goal of phase 1 is pain relief. Pain modalities and over the counter NSAIDs are indicated.
- Counterforce bracing may be efficacious in some patients, but it can exacerbate compressive neuropathies.
- Regain range of motion of the elbow and wrist
- Increase strength. This phase usually involves guided physical therapy.
- Returning to sport/activity. This phase involves correction of the underlying cause, such as poor technique, equipment issues, or lack of conditioning, which is imperative in maintaining symptom relief.
[Medial Epicondylitis resources listed under References section]