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Medial Epicondylitis

Medial Epicondylitis commonly known as Golfer’s elbow is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and microtears in the tendons that attach to the medial epicondyle. The medial epicondyle is the bony prominence that is felt on inside of the elbow.

Medial epicondylitis and lateral epicondylitis (tennis elbow) are similar except that medial epicondylitis occurs on the inside of the elbow and lateral epicondylitis occurs on the outside of the elbow. Both conditions are a type of tendonitis which literally means “inflammation of the tendons”.

Signs and symptoms

Signs and symptoms of medial epicondylitis can include the following:

  • Elbow pain that appears suddenly or gradually
  • Achy pain to the inner side of the elbow during activity
  • Elbow stiffness with decreased range of motion
  • Pain may radiate to the inner forearm, hand or wrist
  • Weakened grip
  • Pain worsens with gripping objects
  • Pain is exacerbated in the elbow when the wrist is flexed or bent forward toward the forearm

Causes

Medial epicondylitis is usually caused by overuse of the forearm muscles and tendons that control wrist and finger movement but may also be caused by direct trauma such as with a fall, car accident, or work injury.

Medial epicondylitis is commonly seen in golfer’s, hence the name Golfer’s elbow, especially when poor technique or unsuitable equipment is used when hitting the ball. Other common causes include any activity that requires repetitive motion of the forearm such as: painting, hammering, typing, raking, pitching sports, gardening, shoveling, fencing, and playing golf.

Diagnosis

Medial epicondylitis should be evaluated by an orthopaedic specialist for proper diagnosis and treatment. Diagnosis includes

  • Medical History
  • Physical Examination
  • An x-ray to rule out a fracture or arthritis as the cause of your pain.
  • Occasionally, if the diagnosis is unclear, your physician may order further tests to confirm golfer’s elbow such as MRI, ultrasonography, and injection test

Conservative treatment options

Your physician will recommend conservative treatment options to treat the symptoms associated with medial epicondylitis. These may include the following:

  • Activity Restrictions: Limit use and rest the arm from activities that worsen symptoms
  • Orthotics: Splints or braces may be ordered to decrease stress on the injured tissues
  • Ice: Ice packs applied to the injury will help diminish swelling and pain. Ice should be applied over a towel to the affected area for 20 minutes four times a day for a couple days. Never place ice directly over the skin
  • Medications: Anti-inflammatory medications and/or steroid injections may be ordered to treat the pain and swelling
  • Occupational Therapy: OT may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased
  • Pulsed Ultrasound: A non-invasive treatment used by therapists to break up scar tissue and increase blood flow to the injured tendons to promote healing
  • Professional instruction: Consulting with a sports professional to assess and instruct in proper swing technique and appropriate equipment may be recommended to prevent recurrence

Surgery

If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend surgery to treat medial epicondylitis. The goal of surgery is to remove the diseased tissue around the inner elbow, improve blood supply to the area to promote healing, and alleviate the patient’s symptoms.

Surgery is performed under local or general anesthesia. Your surgeon will make an incision over the medial epicondyle area, move the soft tissues aside so as to clearly see the area where tendons meet the epicondyle. Then the tendon is cut and any scar tissue and bony spurs will be removed. Finally the tendon will be re-attached to the bone with sutures and incision will be closed.

Following the surgery your surgeon may recommend you to practice certain measures so as to improve the outcomes of surgery and to fasten the process of healing. Occupational therapy and rehabilitation procedures may also be ordered.