Medial Epicondylitis

What is Medial Epicondylitis?

Medial Epicondylitis, also known as golfer's elbow or baseball elbow, is a condition characterized by pain and tenderness of the medial elbow (the inner part of the elbow). It is caused by damage to the tendons (strong tissue that connects muscle to bone) that cause the wrist to flex (bend the wrist moving palm towards arm). Medial epicondylitis is the most common cause of medial elbow pain. However, medial epicondylitis is not as common as lateral epicondylitis (pain on the outside of the elbow, aka tennis elbow), which is discussed in another section.

Who gets medial epicondylitis?

Men tend to get medial epicondylitis about twice as often as women. There is no racial predilection. The peak incidence occurs in people age 20-49 years, but medial epicondylitis can be seen in teens and older adults. The following activities may cause or aggravate medial epicondylitis:

	Carrying a heavy suitcase
	Throwing a baseball at high velocity
	Using a spin serve or using great force in a tennis serve or hitting with excess topspin
	Swinging a golf club
	Throwing a javelin
	Operating a chain saw
	Frequent use of hand tools
	Chopping wood
	Archery
	Weightlifting
	Bowling
	Use of rotational power tools such as drills

What are the symptoms of medial epicondylitis?

	Pain associated with gripping or squeezing motion of the hand (such as carrying a suitcase)
	Pain associated with throwing motion
	Grip weakness
	Up to 50% of patients have occasional or constant numbness or tingling radiating to their fourth and fifth fingers (ring and small fingers), indicating that there may also be impingement of the ulnar nerve (a nerve that runs behind the medial elbow to supply sensation and motor to the hand).

What are the causes of medial epicondylitis?

It is commonly caused by forceful or repetitive use of the muscles that cause your wrist to flex. The wrist flexors of the hand attach to the medial epicondyle and with strain, they become inflammed, resulting in pain and tenderness over the medial epicondyle. Movements such as flexing the wrist, grasping, gripping, and turning of the wrist may lead to medial epicondylitis. At times the inflammation may also result from direct injury or strain. Be sure to tell your doctor if you've recently had trauma to your elbow. Rarely medial epicondylitis may be caused by gout, arthritis, or rheumatism.

How is it diagnosed?

Medial epicondylitis can be diagnosed by:

	Tenderness over the medial epicondyle (the bony part of the inner elbow), made worse by flexing the wrist or pronation (turning the palm down) against resistance
	Pain that becomes worse with squeezing a ball or gripping a tool

What will happen when I visit the doctor's office?

Your physician will first ask you various questions about your pain. For instance, when it started, what makes it worse, what makes it better, etc. Afterward, a physical exam will be performed. Your physician may also order x-rays of your arm to help rule out other causes of elbow pain. Depending on the patient and physician, other tests may also be performed.

How is medial epicondylitis treated?

Treatment includes:

	Rest and discontinuation of the activity resulting in over use of the elbow
	Ice is a first-line anti-inflammatory treatment. Use a prepackaged bag of frozen peas wrapped in a towel to improve contact. Apply to area for 5-10 minutes, four times a day
	A wrist splint which immobilizes the wrist and limits the stresses at the elbow
	Compression with a medial counterforce brace (tennis elbow brace worn with the pad on the middle and front aspect of the elbow
	Heat/ultrasound therapy
	Medications such as non-steroidal anti-inflammatory drugs (Advil, Motrin) which reduce the inflammation and relieve pain
	Injection of the affected area with a corticosteroid results in rapid improvement of symptoms
	Once the acute episode of pain has resolved, physical therapy begins with gentle stretching, progressing slowly to exercise with resistance
	If conservative measures fail (usually 6-12 months) surgery can be considered to remove scar tissue around the medial epicondyle, full return to activity takes 4-6 months

When can I resume activities?

Resuming activities is limited by an individual patient's symptoms. It usually takes 1-6 weeks of treatment with rest, ice, splint, and compression to decrease inflammation and pain.

How can recurrence of medial epicondylitis be prevented?

	Equipment modification-increase the grip size on their equipment (golf club, tennis racquet, and hammer)
	Technique improvement-decrease grip pressure (i.e. golf, tennis) and limit heavy pushing, pulling, or grasping. Minimize repetitive motions or avoid the repetitive activity if possible. Tennis players should improve poor serves and forehand strokes and avoid excessive top-spin.
	Training modification-decrease duration and intensity of activity. Patients should warm-up with a series of increasing activities, take frequent breaks and improve overall muscle condition.

What is the prognosis for medial epicondylitis?

Overall the prognosis is good, with few patients requiring injections and even fewer progressing to surgery. However, as a general rule, the longer a patient delays treatment, the longer the recovery period will be.

-Eric Johnson, MSIV