eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions

Medial Epicondylitis: Differential Diagnoses & Workup

Author: Sharon J Gibbs, MD, Physiatrist, Multidisciplinary Spine Practice at Texas Back Institute
Coauthor(s): Kenneth S Dauber, MD, PA, Consulting Staff, Department of Physical Medicine and Rehabilitation, Plano Orthopedic and Sports Medicine Center
Contributor Information and Disclosures

Updated: Aug 12, 2009

Differential Diagnoses

Lateral Epicondylitis
Olecranon Bursitis

Other Problems to Be Considered

Arthritis
Cervical radiculopathy
Flexor-pronator strain
Pronator teres syndrome
Shoulder musculoskeletal injuries
Thoracic outlet syndrome
Ulnar collateral ligament injury
Ulnar neuropathy

Workup

Laboratory Studies

  • Laboratory studies are generally not indicated in ME.

Imaging Studies

  • A radiograph of the elbow is often performed to rule out associated lesions (eg, loose bodies, bony avulsion, osteoarthritis). Typically, anteroposterior and lateral films are adequate.
  • Oblique views are needed if loose bodies are suggested upon examination or because of a catching or clicking sensation described by the patient.
  • Valgus stress radiographs should be obtained if medial instability is suggested.
  • Magnetic resonance imaging (MRI) may be helpful in looking for the characteristic pathology that is seen in chronic cases of ME; MRI also permits assessment of the medial collateral ligament and ulnar nerve.5  Although in most cases an MRI scan is not necessary, it should be considered in individuals with atypical symptoms or in patients who are not responsive to conservative measures.
  • Research suggests that ultrasonography also is useful for the diagnosis of ME. In a prospective, single-blind study, Park et al found that ultrasonographic findings were positive in 20 of 21 elbows with ME and were negative in 23 of 25 elbows without ME.6  According to the investigators, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ultrasonography in the diagnosis of clinical ME were, respectively, 95.2%, 92%, 93.5%, 90.9%, and 95.8%. They therefore recommended that ultrasonography be considered as an initial imaging modality in the evaluation of ME.

Other Tests

  • If ulnar nerve involvement is suggested, a nerve conduction study and electromyography should be performed.

More on Medial Epicondylitis

Overview: Medial Epicondylitis
Differential Diagnoses & Workup: Medial Epicondylitis
Treatment & Medication: Medial Epicondylitis
Follow-up: Medial Epicondylitis
Multimedia: Medial Epicondylitis
References
Further Reading
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References

  1. Rineer CA, Ruch DS. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg Am. Mar 2009;34(3):566-76. [Medline].

  2. Budoff JE, Hicks JM, Ayala G, et al. The reliability of the "scratch test". J Hand Surg Eur Vol. Apr 2008;33(2):166-9. [Medline].

  3. van Rijn RM, Huisstede BM, Koes BW, et al. Associations between work-related factors and specific disorders at the elbow: a systematic literature review. Rheumatology (Oxford). May 2009;48(5):528-36. [Medline].

  4. Farber AJ, Smith JS, Kvitne RS, et al. Electromyographic analysis of forearm muscles in professional and amateur golfers. Am J Sports Med. Feb 2009;37(2):396-401. [Medline].

  5. Banks KP, Ly JQ, Beall DP, et al. Overuse injuries of the upper extremity in the competitive athlete: magnetic resonance imaging findings associated with repetitive trauma. Curr Probl Diagn Radiol. Jul-Aug 2005;34(4):127-42. [Medline].

  6. Park GY, Lee SM, Lee MY. Diagnostic value of ultrasonography for clinical medial epicondylitis. Arch Phys Med Rehabil. Apr 2008;89(4):738-42. [Medline].

  7. Krischek O, Hopf C, Nafe B, et al. Shock-wave therapy for tennis and golfer's elbow--1 year follow-up. Arch Orthop Trauma Surg. 1999;119(1-2):62-6. [Medline].

  8. Gabel GT, Morrey BF. Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow. J Bone Joint Surg Am. Jul 1995;77(7):1065-9. [Medline].

  9. Carson WG. Overuse injuries of the elbow in the throwing athlete. In: Baker CL, ed. The Hughston Clinic Sports Medicine Book. Baltimore, Md: Williams & Wilkins; 1995:324-31.

  10. Ciccotti MG, Ramani MN. Medial epicondylitis. Tech Hand Up Extrem Surg. Dec 2003;7(4):190-6. [Medline].

  11. Gabel GT, Morrey BF. Medial epicondylitis. In: Morrey BF, ed. The Elbow and Its Disorders. 3rd ed. Philadelphia, Pa: WB Saunders; 2000:537-42.

  12. Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. Feb 1999;81(2):259-78. [Medline].

  13. Ollivierre CO, Nirschl RP, Pettrone FA. Resection and repair for medial tennis elbow. A prospective analysis. Am J Sports Med. Mar-Apr 1995;23(2):214-21. [Medline].

  14. Stahl S, Kaufman T. The efficacy of an injection of steroids for medial epicondylitis. A prospective study of sixty elbows. J Bone Joint Surg Am. Nov 1997;79(11):1648-52. [Medline].

  15. Stahl S, Kaufman T. Ulnar nerve injury at the elbow after steroid injection for medial epicondylitis. J Hand Surg [Br]. Feb 1997;22(1):69-70. [Medline].

  16. Vangsness CT Jr, Jobe FW. Surgical treatment of medial epicondylitis. Results in 35 elbows. J Bone Joint Surg Br. May 1991;73(3):409-11. [Medline]. [Full Text].

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Further Reading

Related eMedicine topics:
Injection, Medial Epicondyle
Lateral Epicondylitis [Orthopedic Surgery]
Lateral Epicondylitis [Physical Medicine and Rehabilitation]
Lateral Epicondylitis [Sports Medicine]
Little League Elbow Syndrome
Medial Epicondylitis [Orthopedic Surgery]
Medial Epicondylitis [Sports Medicine]
Overuse Injury

Clinical guidelines:
ACR Appropriateness Criteria® chronic elbow pain. American College of Radiology - Medical Specialty Society.  1998 (revised 2008).  8 pages.  NGC:006997

Elbow (acute & chronic). Work Loss Data Institute - Public For Profit Organization.  2003 (revised 2008 May 28).  161 pages.  NGC:006555

Elbow disorders. American College of Occupational and Environmental Medicine - Medical Specialty Society.  1997 (revised 2007).  67 pages.  NGC:005681

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Keywords

medial epicondylitis, elbow pain, epicondylitis, tendonitis elbow, elbow injury, overuse injuries, elbow tendinitis, overuse injury, golfer's elbow, medial tennis elbow, reverse tennis elbow

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Contributor Information and Disclosures

Author

Sharon J Gibbs, MD, Physiatrist, Multidisciplinary Spine Practice at Texas Back Institute
Sharon J Gibbs, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and Texas Medical Association
Disclosure: emedicine Honoraria Other

Coauthor(s)

Kenneth S Dauber, MD, PA, Consulting Staff, Department of Physical Medicine and Rehabilitation, Plano Orthopedic and Sports Medicine Center
Kenneth S Dauber, MD, PA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Daniel D Scott, MD, MA, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver and Health Sciences Center
Daniel D Scott, MD, MA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, National Multiple Sclerosis Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

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