Medial epicondylitis, more commonly known as "golfer's elbow" or "pitchers elbow" is an overuse condition in which the flexor tendon develop tendinosis and inflammation in response to repetitive overload.
The medial common flexor tendon attaches to the inside portion of the elbow, called the medial epicondyle of the humerus. There are five muscles that attach to the medial epicondyle that for the medial common flexor tendon (pronator teres, flexor carpi radialis, flexor carpi ulnaris, palmaris longus and the flexor digitorum superficialis).
Activities such as repetitive twisting, gripping or valgus stress to the elbow can aggravate these muscles and tendon
While medial epicondylitis is common in athletes who participate in sports such as golf or baseball, this condition is also common in plumbers, mechanics and many more sporting activities that require repetitive valgus stress or gripping.
Signs and symptoms
Patients' with medial epicondylitis typically have pain most prominent on the inside portion of the elbow where the common flexor tendon attaches to the medial epicondyle. Patients may complain of achiness, burning sensations, elbow stiffness or swelling. Additionally, pain may be increased during the night time.
Pain is usually exacerbated with resisted wrist flexion, carrying objects, using a wrench or opening a tight jar.
The diagnosis of medial epicondylitis can be made by physical examination by a skilled provider. Occasionally, imaging such as x-rays or and MRI may be warranted to rule out other conditions such as stress fractures or ligamentous injuries.
Medial epicondylitis can be treated nonoperatively with activity modification, anti-inflammatories and physical therapy. Some patients find bracing to be helpful as well.
Occasionally, for those who fail conservative management with activity modification, physical therapy oral or topical anti-inflammatories, a steroid injection may be beneficial.
Other treatment options for this condition can include OSKA pulse magnetic therapy, cold laser therapy, PRP injections and rarely operative management.
Operative management for medial epicondylitis is only recommended if patients fail all of the above conservative measures. Operative management can be performed either arthroscopically (with a scope) or open to excise and repair the diseases portion of tendon.