Medial elbow tendinopathy or medial epicondylitis, commonly called "golfer's elbow," is caused by repetitive overuse of the wrist flexor and forearm pronator muscles that originate at the medial epicondyle of the humerus. Patients present due to pain in the medial aspect of the elbow, rarely weakness, and loss ROM. Pain is worsened by gripping and lifting activities, particularly with the hand in palm-up position. Common
Figure 30-16 Medial epicondylitis may be diagnosed clinically by pain localized to the medial epicondyle during wrist flexion and pronation against resistance. There is often pain elicited after making a tight fist, and grip strength is usually diminished on the affected side.
(From Morrey BF [ed]: The Elbow and its Disorders. Philadelphia, Saunders, 1985.)
positive findings include tenderness to palpation of the medial epicondyle of the elbow and over the proximal wrist flexor and forearm pronator muscle tendons. Pain is intensified with resisted wrist flexion and forearm pronation (Fig. 30-16). Patient discomfort often limits strength. Elbow motion, ligamentous stability, and neurovascular status are typically intact.
As with lateral elbow tendinopathy, plain radiographs are not needed to make an accurate diagnosis of medial elbow tendinopathy, but should be considered with a history of trauma, motion loss, locking, or chronic pain. Also similar to lateral epicondylitis, management of medial epicondylitis includes ice, medications, injections, and straps. However, cor-ticosteroid injections are not recommended because of possible ulnar nerve injury. In medial elbow tendinopathy, the most effective stretch is performed with the elbow extended and the wrist and fingers gently pulled into full extension. The forearm can be pronated or supinated. Strengthening focuses on wrist flexion and forearm pronation exercises.
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