Definition

Medial epicondylitis is pain over the bone on the inner side of the elbow. The piece of bone that can be felt on the inner side of the elbow is called the medial epicondyle. When the tendons attached to this bone are overstretched or torn, they can become painful. This is called tendinopathy .

Medial epicondylitis is commonly called golfer's elbow, but it is not restricted to people who play golf. It can occur in tennis players and other people who repeatedly grip objects tightly.

Medial Epicondylitis
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Causes

Golfer's elbow is caused by overusing the flexor muscles of the forearms. Overusing these muscles can stretch or tear the tendons attached to the medial epicondyle.

Causes include:

  • Improper golf swing technique or grip of golf clubs
  • Wrong model of golf clubs
  • Improper technique for hitting a tennis ball
  • Improper size of tennis racquet or tension of racquet strings
  • Doing certain arm motions too much, such as:
    • Golf swings
    • Tennis strokes (forehand or serve)
    • Painting
    • Raking
    • Pitching
    • Rowing
    • Using a hammer or screwdriver

Risk Factors

Factors that may increase your chance of medial epicondylitis include:

  • Playing golf or tennis
  • Work that requires repetitive gripping or clenching of the fingers (especially when the hand is bent up or down at the wrist)
  • Muscle imbalance
  • Decreased flexibility
  • Increased age

Symptoms

Symptoms include:

  • Pain or tenderness on the inner side of the elbow
  • Pain increases when:
    • Shaking hands
    • Turning doorknobs
    • Picking up objects with your palm down
    • Hitting a forehand in tennis
    • Swinging a golf club
    • Applying pressure to this area
  • Possibly pain extending down the forearm
  • Tightness of forearm muscles
  • Stiffness or trouble moving the elbow or hand

Diagnosis

You will be asked about your symptoms, medical history, recent physical activity, and how the injury occurred. You may not remember the event that caused the injury because golfer's elbow pain develops over time. The doctor will examine your elbow for:

  • Pain on the inner side of the elbow when:
    • Doing certain arm motions
    • Pressing on the medial epicondyle
  • Stiffness of elbow and pain with wrist movement

X-rays are not usually necessary. However, an x-ray may be needed if the doctor suspects other problems.

An MRI scan is occasionally used for diagnosis, but there is only limited evidence supporting this use.

Treatment

Treatment includes:

Rest

Activities will need to be limited, including sports such as golf and tennis.

Cold

Regular ice application may help decrease some discomfort and swelling.

Medication

Mediations may be advised to reduce inflammation and pain:

  • Nonsteroid anti-inflammatory drugs (NSAIDs)
  • Acetaminophen
  • Topical pain relievers that are applied to the skin

Compression

A counter-force brace can be worn on the forearm if advised by a doctor. This brace limits the force generated by the forearm muscles when in use.

Heat

Heat can be applied to the elbow when returning to physical activity and before stretching or getting ready to play sports.

Stretching

When the acute pain is gone, gentle stretching can be done as tolerated.

Strengthening

Strengthening exercises for the flexor muscles of the forearm will be advised.

Gradual Return to Your Sport

Begin arm motions of the sport or activity as advised. Examples include golf swings, tennis strokes, or painting strokes.

Cortisone Injection

The doctor may inject cortisone into the elbow near the medial epicondyle to reduce pain and inflammation.

Prevention

To help reduce your chance of medial epicondylitis:

  • Keep your arm muscles strong so they can absorb the energy of sudden physical stress.
  • After a short warm-up period, stretch your arm muscles before physical activity.
  • Learn the proper technique for activities that require forearm motion.
  • If you play golf, ask a golf specialist to check your:
    • Swing technique
    • Grip
    • Model of golf clubs
  • If you play tennis, ask a tennis specialist to check your:
    • Technique for hitting a forehand
    • Racket size and tension of racket strings

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