Medial Epicondylitis/Golfer’s Elbow
What is medial epicondylitis?
It is tendinosis (degeneration, not inflammation) of the tendon insertion of the muscles that flex the wrist and pronate the forearm (turn the hand palm down) at the elbow. It is very common, but not anywhere near as common at lateral epicondylitis or tennis elbow.
What are the symptoms of medial epicondylitis?
The most common symptoms are a pain at the inside of the elbow with grip, lifting or swinging a racket/stick with the sport. In addition, almost all will have pain at the bump on the inside of the elbow (medial epicondyle of the humerus).
Who gets medial epicondylitis?
The age range is similar to those with lateral epicondylitis: 35- 65 years old. While tennis elbow is usually not caused by tennis, golfers’ elbow can be caused by golf, especially if one’s swing needs “some work”. Other causes can be overuse with any type of lifting exercise, improper weight lifting (straight bar biceps curls), or sudden pulling with the wrist flexed.
Patients often have pain inside the elbow with use or activity.
How is medial epicondylitis diagnosed?
A thorough history and physical examination will usually make the diagnosis. It is important to make sure that there is no compression or injury of the ulnar nerve at the elbow. X-rays are usually done to rule out arthritis. An MRI is not essential but is diagnostic.
How is medial epicondylitis treated?
It is important to remember that the condition is a result of tendon degeneration, not inflammation. For this reason, traditional anti-inflammatory medications do not work. These include NDAIDS and steroid injections. There are no definitive studies telling us what treatment works best. In addition, most all treatments work the same as doing nothing. Therefore, I set patients up with a trial of physical therapy. Eccentric exercises and aggressive soft tissue mobilization set up by a trained therapist with a home program will usually decrease symptoms and allow the patient to return to sport. There is no need to wait for healing to return to sports or work either. I believe that if a patient will do the exercises before their activity, they will be able to perform better and without pain. The program should be incorporated as part of the warm-up.
Rarely, one may need surgical treatment. The surgery is simple–but will require post-operative immobilization for 10-14 days and then a supervised therapy regimen.
