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medial epicondylitis (golfer's elbow)
Pain at the medial epicondyle of the elbow due to tendonitis/tendinosis of the pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris &/or flexor sublimis.
Etiology:
1) repetitive eccentric flexor/pronator overload
2) in tennis, repeated flexion during serve or imparting top spin on forehand strokes
3) in golf, improper swing mechanics
Clinical manifestations:
1) pain & tenderness over medial elbow worsened by resisted wrist flexion or forearm pronation
2) motion may be absent with chronic cases
Laboratory: generally of no value
Radiology: indicated in cases of trauma
Differential diagnosis: (also see epicondylitis)
1) tenderness more anterior or pain with application of valgus stress suggests medial collateral ligament injury
2) tenderness over cubital tunnel (posterior to medial epicondyle) & positive Tinel's sign or Phalen's sign are suggestive of ulnar nerve entrapment
3) valgus extension overload
4) T1 nerve root radiculopathy
Management:
1) see epicondylitis
2) stretching & strengthening exercises
3) avoidance of activities that exacerbate the pain
- prevent pronation
4) elbow brace may be helpful
5) NSAIDs (topical & oral)
6) steroid/local anesthetic injection (avoid ulnar nerve)
- avoid glucocorticoid injections [3]
Related
epicondylus medialis humeri (medial epicondyle of humerus or elbow, epitrochlea)
General
epicondylitis
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 769-71
- Clyman B, in: UCLA Intensive Course in Geriatric Medicine &
Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022