Updated: 1/16/2019

Medial Epicondylitis

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Snapshot
  • A 46-year-old man presents to his primary care physician for right-sided elbow pain. He describes the pain as sharp and worsens when performing arm curls or playing golf. He denies any direct trauma to the elbow. On physical exam, there is tenderness upon palpation of the medial elbow. Pain is elicited with resisted wrist flexion while the elbow is fully extended. 
Introduction
  • Clinical definition
    • an overuse syndrome that results in pain in the myotendinous junction between the wrist flexors and medial epicondyle
      • also known as "golfer's elbow"
  • Epidemiology
    • incidence
      • it is less common than lateral epicondylitis
      • more common in activities that result in repetitive
        • wrist flexion
        • forearm pronation
    • demographics
      • typically between 40-60 years of age
  • Etiology
    • microtrauma and degeneration of the flexor tendons
    • a single traumatic event such as
      • a direct blow to the medial elbow
      • sudden extreme eccentric contraction
  • Pathoanatomy
    • the medial epicondyle is the bony origin for the wrist flexors and involve the
      • pronators teres muscle
      • flexor carpi radialis muscle
    • repetitive wrist flexion and forearm pronation activities results in an angiofibroblastic tendinosis
  • Prognosis
    • may be self-limited
Presentation
  • Symptoms
    • pain in the medial elbow
      • worsened with wrist flexion and forearm pronation
      • pain onset is typically insidious
  • Physical exam
    • tenderness at the medial epicondyle
    • pain upon resisted wrist flexion
      • performed with the elbow extended
    • pain upon passive wrist extension
      • performed with the elbow extended
Imaging
  • Radiography
    • performed in recalcitrant cases
Studies
  • Making the diagnosis
    • a clinical diagnosis
Differential
  • Lateral epicondylitis 
    • distinguishing factor
      • patients present with lateral elbow pain
Treatment
  • Conservative
    • activity modification
      • indication
        • an initial intervention performed in all patients
    • physical therapy
      • indication
        • an initial intervention performed in all patients
  • Operative
    • orthopedic surgery
      • indication
        • typically performed in patients who failed physical therapy for 4-6 months
Complications
  • Functional disability
 

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