Orthopaedic Surgery/Medial Epicondylitis

Orthopaedic Surgery

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Current Chapter: Upper Limb

Medial Epicondylitis
<<Lateral Epicondylitis Baseball Pitcher's Elbow>>

Medial epicondylitis is sometimes known as golfer's elbow.

Golfers Elbow is a problem with the flexor muscle mechanism of the wrist - in other words the group of muscles whose job it is to flex the wrist joint. These muscles are attached to the facet on the anterior aspect of the medial epicondyle at the elbow.

Golfers elbow or medial epicondylitis is much less common than tennis elbow or lateral epicondylitis.

Features of Medial Epicondylitis

  • Pain at the medial epicondyle or inner side of the joint
  • A history of overuse
  • Expect to find normal range of movement on passive testing of the joint

The main "golfers" sign is pain on resisted flexion of the wrist - more so if tested with the elbow held in the extended position during testing.

The site of inflammation is almost invariably at the teno-osseous junction where the common flexor tendon meets the medial epicondyle at its anterior aspect. The teno-osseous junction is the part where the tendon tissue joins with the bone.

The pain may be felt by the patient further down the arm in the muscle belly of the flexors in the forearm - this pattern of referred pain can sometimes cause confusion.

Treatment of golfers elbow There are three main options for golfers elbow treatment - but keep in mind that the natural history is for spontaneous resolution in the majority of cases

  • Conservative - Avoid provoking activity or change sports equipment (grip size of tennis racket or golf clubs). Short term anti-inflammatory medication and reassure strongly. Consider using an epicondylar clasp for symptom relief.
  • Physiotherapy - reasonable success rate although may require several treatments before substantial improvement is seen. Treatment needs to be backed up by education on stretching and prevention of recurrence.
  • Injection of steroid and local anaesthetic - the most cost effective option. No difference from physiotherapy in long term outcome but works more quickly and is much more cost effective.

Author: Dr Gordon Cameron