Medial epicondylitis
Medial epicondylitis, or golfer's elbow, is overuse tendinosis of the common flexor-pronator origin diagnosed clinically by medial epicondyle tenderness reproduced with resisted wrist flexion and forearm pronation, managed first with activity modification and NSAIDs before bracing, injection, or surgery.
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What this article covers
- Overview
Overuse tendinosis of the flexor-pronator origin: medial epicondylitis (golfer's elbow) is a form of elbow tendinopathy, specifically degenerative tendinosis of the common flexor-pronator tendon at…
- Epidemiology
Less common than lateral epicondylitis: medial epicondylitis occurs less frequently in clinical practice than its lateral counterpart, though both share a similar demographic.
- Risk factors
Repetitive wrist flexion and forearm pronation: activities requiring sustained or repeated resisted wrist flexion and pronation, such as a golf swing or throwing motion, are the dominant mechanical risk factor.
- Pathophysiology
Tendinosis, not inflammation: repetitive microtrauma to the flexor-pronator origin (pronator teres and flexor carpi radialis primarily) produces vascular hyperplasia, fibroblast hypertrophy, and…
- Clinical features
Medial elbow pain with tenderness at the epicondyle, reproduced by resisted wrist flexion and pronation, establishes the diagnosis: pain and tenderness are located over the medial epicondyle and are…
- Differential diagnosis
Cubital tunnel syndrome (ulnar neuropathy at the elbow): medial elbow pain that worsens with elbow flexion, with paresthesia and numbness of the fourth and fifth fingers and interosseous muscle…
- Diagnosis
Medial epicondylitis is a clinical diagnosis confirmed by reproducible tenderness at the medial epicondyle with pain on resisted wrist flexion and forearm pronation: no laboratory testing, imaging…
- Management
First, modify or avoid the pain-inducing activity (golf swing, throwing motion, repetitive gripping) as the foundation of treatment, since ongoing loading of the tendon prevents healing.
- Complications
Chronic refractory tendinosis: a subset of patients fail conservative measures and develop persistent pain lasting beyond 6 months.
- Prognosis
Generally favorable with conservative care: most patients improve with activity modification, NSAIDs, bracing, and physical therapy over weeks to a few months.
- Prevention
Modify swing or throwing mechanics for golfers and throwing athletes: correcting technique reduces repetitive loading of the flexor-pronator origin.
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- Lateral epicondylitis
Lateral epicondylitis, or tennis elbow, is overuse tendinosis of the extensor carpi radialis brevis origin diagnosed clinically by lateral epicondyle tenderness reproduced with resisted wrist extension, managed first with activity modification and NSAIDs, then bracing and physical therapy, reserving corticosteroid injection and surgery for refractory disease.
- Elbow tendinopathy
Elbow tendinopathy (tennis or golfer's elbow) is an overuse degenerative tendinosis at the lateral or medial epicondyle diagnosed clinically by localized tenderness reproduced with resisted wrist motion. Management is a staged sequence of activity modification, NSAIDs, eccentric exercise, and, only for refractory cases, peritendinous injection or surgery.
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