Medial epicondylitis

Medial epicondylitis or “golfer’s elbow”, is a painful tendinitis condition that causes discomfort along the inside of the elbow.  The muscles that flex the wrist and fingers insert into a portion of the bone on the inside of the elbow called the “medial epicondyle”.  Small tears of the muscle at its insertion site (the tendon) is a common cause of pain in the area that is experienced when lifting or grasping objects, or activities such as closing doors, throwing objects or swinging a golf club.

Causes

Common causes include overuse, or trauma to the forearm muscles, such sports (golfing, racket sports, throwing sports), weightlifting, or use of tools.  It is more common in the dominant hand, and tends to occur in individuals between 30 and 60 years of age.

Diagnosis

Medial epicondylitis can be diagnosed by talking with your doctor and having them examine your elbow.  There is often pain when pushing on the “medial epicondyle”, and when resisting wrist or finger flexion, or when pronating the forearm (turning the palm towards the floor).  Sometime the inflammation may irritate the nearly ulnar nerve, which can cause tingling or pain in the small and ring finger, and weakness in the hand muscles.

Non-operative treatment

A counterforce strap decreases tension on the site of the tendon tear, which can decrease pain and facilitate healing.

  • Activity modification – avoid aggravating activities

  • Anti-inflammatories (if medically safe)

    • Diclofenac gel (Voltaren or Pennsaid)

    • Oral over-the-counter NSAIDs (ibuprofen or naproxen)

  • Therapy to stretch the forearm muscles

  • Steroid injection into site of pain and inflammation

With your elbow straight and palm facing the floor, make a fist. Then, use your other hand to bend the wrist down. Hold the stretch for 30 seconds.

With your elbow straight and palm facing the floor, use your other hand to bend the wrist and fingers backward. Hold the stretch for 30 seconds.

Treatment for golfers

  • Stretch before playing and warm up appropriately

  • Avoid overuse and over-swinging

  • Ice after use

  • Therapy

    • Focusing on strengthening back (latissimus dorsi) and chest (pectoralis) muscles

    • Weakness in chest and back muscles can alter posture and swing mechanics, thereby producing excessive stress on the elbow

    • Eccentric stretching of forearm muscles

  • Equipment modification(s)

    • Larger grips

    • Graphite shafts – more flexible and absorb shocks better than steel shafts

    • Cavity backed irons (larger sweet spot) dampen vibrations transmitted through forearm to elbow

    • Woods and hybrids produce less resistance and reverberations at impact

Surgery

  • Surgery is rarely required, as the condition tends to improve with time

  • If over 6 months have passed, one may consider surgically repairing the torn muscle/tendon back to the bone. Oftentimes an MRI is first performed to evaluate the extent and location of the injury

Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.

Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.