eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions
Medial Epicondylitis
Updated: Nov 26, 2007
Introduction
Background
Medial epicondylitis (ME) is an overuse injury affecting the flexor-pronator muscle origin at the anterior medial epicondyle of the humerus. ME is often discussed in conjunction with lateral epicondylitis (LE), which occurs much more frequently. ME is the most common cause of medial elbow pain, although the clinician is likely to see at least 5 cases of LE for every case of ME. Patients who develop medial elbow pain appreciate their physician's knowledge of the subtle differences in the diagnosis and treatment of the 2 disorders. (See also Medial Epicondylitis [in the Orthopedic Surgery section], Medial Epicondylitis [in the Sports Medicine section], and Overuse Injury.)
Pathophysiology
ME involves primarily the flexor-pronator muscles (ie, pronator teres, flexor carpi radialis, palmaris longus) at their origin on the anterior medial epicondyle. Less often, ME also affects the flexor carpi ulnaris and flexor digitorum superficialis. Repetitive stress at the musculotendinous junction and its origin at the epicondyle leads to tendinitis in its most acute form and to tendinosis in its more chronic form. In addition, an ulnar neuropraxia caused by compression of the ulnar nerve in or around the medial epicondylar groove has been estimated to occur in up to 50% of ME cases.
The tendinosis that occurs is primarily the result of failure of the damaged tendon to heal. Microscopic examination of the involved tissue shows granulation tissue, fibrovascular and fibrocartilaginous tissue, tendon microfragmentation, calcification, and necrosis. Histologically, damage to the involved tendons has been described as angiofibroblastic hyperplasia tendinosis and fibrillary degeneration of collagen. A simple, acute inflammatory reaction is noted to be a much less common finding than are the previously described tendinosis changes.
Race
No studies indicate a race predilection.
Sex
A male-to-female ratio of 2:1 has been reported.
Age
Peak incidence is in patients aged 20-49 years, but ME is also seen in teens and older adults, especially if they engage in hobbies, jobs, or sports activities that make them prone to overuse injuries. (See also the article Prevalence of Orthopaedic Maladies in People Who Flyfish: An Internet-Based Survey, on Medscape.)
Clinical
History
ME is characterized by pain over the medial epicondyle. Pain worsens with wrist flexion and forearm pronation activities. Patients may report discomfort even when simply shaking hands with someone. Up to 50% of patients with ME complain of occasional or constant numbness and/or tingling sensation that radiates into their fourth and fifth fingers, suggesting involvement of the ulnar nerve.
The patient's history may include the occurrence of an acute injury as a result, for instance, of taking a divot in golf, throwing a pitch in baseball, or hitting a hard serve in tennis.
Physical
Tenderness with palpation over the anterior aspect of the medial epicondyle is the most consistent finding. Other characteristics of ME include the following:
- Typically, pain is reproduced with resisted wrist flexion or resisted forearm pronation.
- Occasionally, the area of tenderness extends approximately 1 inch toward the proximal flexor-pronator muscle mass just distal to the epicondyle.
- The range of motion of the elbow and wrist is usually within normal limits.
- Patients may have symptoms of an ulnar neuropathy (eg, decreased sensation in the ulnar nerve distribution, a positive elbow-flexion test, a positive Tinel sign). In more severe cases, decreased sensation is associated with intrinsic weakness; intrinsic muscle atrophy may be noted.
Causes
The causes of ME include the following:
- The condition can result from the repetitive use of flexor-pronator muscles, especially with valgus stress at the medial epicondyle.
- The onset can be related to the patient's occupation (if, for example, his/her job requires repetitive actions, such as the consistent use of a screwdriver or hammer).
- ME's onset can accompany acute injury.
- An excessive topspin in tennis, excessive grip tension, improper pitching techniques in baseball, and an improper golf swing are common sports-related causes of ME.
More on Medial Epicondylitis |
 Overview: Medial Epicondylitis |
| Differential Diagnoses & Workup: Medial Epicondylitis |
| Treatment & Medication: Medial Epicondylitis |
| Follow-up: Medial Epicondylitis |
| Multimedia: Medial Epicondylitis |
| References |
| Next Page » |
References
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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].
Further Reading
Keywords
golfer's elbow, medial tennis elbow, reverse tennis elbow
