Medial epicondylitis A.K.A Golfer's elbow

Medial Epicondylitis is a common cause of inner elbow pain.

What is medial epicondylitis?

Medial epicondylitis, also known as Golfer’s elbow, is mostly an overload injury to the inner forearm tendons that leads to an inflammatory condition called a tendinopathy. The most sensitive region is located along the elbow near the origin of the wrist flexors on the medial epicondyle of the humerus. Due to injury or chronic overuse, the tendons that attach the flexor muscles to the humerus become irritated causing swelling and pain. When compared to Tennis elbow/Lateral epicondylitis; Golfer's elbow has a lower incidence. Even though it is known as Golfer's elbow 90% to 95% of all cases do not involve sports participation. Occupations such as carpentry, plumbing and meat cutting have been implicated because of the chronic repetitive contractile loading of the wrist flexor and pronator muscles.


Causes and Risk factors

Medial epicondylitis is caused when too much force is used to bend the wrist toward the palm of the forearm. This can happen when swinging a golf club or pitching a baseball. Other possible causes of the condition can be serving with great force in tennis or frequent use of other hand tools on a continuous basis. Weak shoulder muscles or wrist muscles can make the patient susceptible to developing the condition.

Some known risk factors are:


Clinical presentation 

The most common symptom of medial epicondylitis is pain and tenderness located along the palm side of the forearm extending from the elbow to the wrist on the ulnar side (same side as the little finger). Other possible findings are weakness at the hands and wrist or sensation of numbness and tingling that radiate into one or more fingers (usually the ring and little finger) due to ulnar nerve irritation. The elbow may feel stiff, and making a fist might hurt. The pain can be aggravated by bending the wrist toward the palm against resistance and by pronation.


What to expect at the doctor's office?

To achieve a diagnosis the physician will complete a physical examination, which may include applying pressure to the elbow, wrist, and fingers to check for stiffness or discomfort. The more common physical exams performed are the passive technique and the active technique.

During the passive technique the patient can be seated or standing, for the exam the physician first palpates the medial epicondyle while supporting the elbow with one hand, and with the other hand passively supinates the patients forearm and fully extends the elbow, wrist and fingers. If sudden pain or discomfort is reproduced along the medial aspect of the elbow in the region of the medial epicondyle, then this test is considered positive. For the active technique the patient needs to be seated with the elbow flexed and the forearm placed palm up (forearm supination); the examiner then grasps the patient’s wrist and elbow and attempts to straighten out the elbow (forced extension) against the patient’s resistance (resisted elbow-wrist flexion). If sudden pain or discomfort is reproduced along the medial aspect of the elbow in the region of the medial epicondyle, then this test is considered positive.

An X-ray can help the doctor rule out other causes of elbow pain, such as a fracture or arthritis. Rarely, more comprehensive imaging studies such as MRI or CT scans need be performed to asses injuries to tissues.


Treatment options

Conservative options:

Most cases may resolve without intervention. Persistent symptoms can be treated by:

Most cases will improve with OTC medication and home remedies. If your signs and symptoms don't respond to conservative treatment in six to 12 months, surgery might be an option.

Surgical option:

This surgery is known as an open medial epicondylar release. The goal of the surgery is to remove the damaged tendon that's causing pain. During the procedure, a surgeon makes an incision in the forearm, cuts the tendon, removes the damaged tissues around the tendon, and then reattaches a healthy tendon in its place. After the healthy tendon is placed the surgeon closes the incision with stitches and applies a bandage. After surgery the arm is put in a soft dressing to limit movements during the first week of recovery; this gives the tendon a chance to heal. At a follow-up appointment in about 10 days, the doctor can remove the stitches and check progress. The patient may get a referral to physical therapy where they can work on strengthening the elbow. Therapy may be needed for two to three months. It can take up to six months to get back to sports and other high-level activities.

Everyone recovers from injury at a different rate so return to your sport or activity will be determined by how soon the elbow recovers and not by how many days or weeks it has been.


How can I prevent it?

You can take these steps as a prevention to developing medial epicondylitis:

Endrina Mangual Valladares MS3 Third year Medical Student at University of Medicine and Health Sciences (UMHS)

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