medial epicondylitis (golfer's elbow)

Introduction

Pain at the medial epicondyle of the elbow due to tendonitis/tendinosis of the pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris &/or flexor sublimis.

Etiology

• repetitive eccentric flexor/pronator overload
• in tennis, repeated flexion during serve or imparting top spin on forehand strokes
• in golf, improper swing mechanics

Clinical manifestations

• pain & tenderness over medial elbow worsened by resisted wrist flexion or forearm pronation
• motion may be absent with chronic cases

Laboratory

generally of no value

Radiology

indicated in cases of trauma

Differential diagnosis

(also see epicondylitis)

• tenderness more anterior or pain with application of valgus stress suggests medial collateral ligament injury
• tenderness over cubital tunnel (posterior to medial epicondyle) & positive Tinel's sign or Phalen's sign are suggestive of ulnar nerve entrapment
• valgus extension overload
• T1 nerve root radiculopathy

Management

• see epicondylitis
• stretching & strengthening exercises
• avoidance of activities that exacerbate the pain
  • prevent pronation
• elbow brace may be helpful
• NSAIDs (topical & oral)
• steroid/local anesthetic injection (avoid ulnar nerve)
  • avoid glucocorticoid injections

More general terms

• epicondylitis

Additional terms

• epicondylus medialis humeri (medial epicondyle of humerus or elbow, epitrochlea)