Background
Medial epicondylitis, or "golfer's elbow," is similar to the more common lateral epicondylitis ("tennis elbow") in many respects. Both conditions are overuse tendinopathies that can be associated with racquet sports. Other activities with which medial epicondylitis is associated include golfing and throwing sports. Medial epicondylitis has also been reported in bowlers, archers, and weight lifters.[1]
Little leaguer's elbow is sometimes considered a variant of medial epicondylitis, but this condition is technically a traction apophysitis of the medial epicondyle, which requires a different treatment course.
For excellent patient education resources, visit eMedicine's Hand, Wrist, Elbow, and Shoulder Center. Also, see eMedicine's patient education article Tennis Elbow.
Epidemiology
Frequency
United States
Medial epicondylitis accounts for only 10-20% of all epicondylitis diagnoses[1] ; this condition is usually found in the dominant elbow of a golfer.[2] Tennis players who hit their forehand with a heavy topspin are also at increased risk for developing medial epicondylitis.
Functional Anatomy
The medial epicondyle is the common origin of the forearm flexor and pronator muscles. The most common site of pathology is the interface between the pronator teres and the flexor carpi radialis origins.[3, 4] The flexor pronator muscle group serves as a secondary stabilizer of the medial elbow, assisting the ulnar collateral ligament (UCL).
Sport-Specific Biomechanics
Immunohistologic studies have shown that long-standing epicondylitis is associated with a degenerative state instead of a traditional inflammatory process and probably should more accurately be called "epicondylosis."[5, 6] Valgus stresses are placed on the elbow by activities such as throwing and golfing; valgus stress on the medial elbow is especially high during the late cocking and acceleration phases of a throw and during a golf swing (from the top of the backswing to just before ball impact).[7]
Plancher KD, Halbrecht J, Lourie GM. Medial and lateral epicondylitis in the athlete. Clin Sports Med. Apr 1996;15(2):283-305. [Medline].
Kohn HS. Prevention and treatment of elbow injuries in golf. Clin Sports Med. Jan 1996;15(1):65-83. [Medline].
Nirschl RP. Prevention and treatment of elbow and shoulder injuries in the tennis player. Clin Sports Med. Apr 1988;7(2):289-308. [Medline].
Nirshal RP. Muscle and tendon trauma: tennis elbow. In: The Elbow and Its Disorders. Philadelphia, Pa: WB Saunders Co; 1993:481-96.
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]. [Full Text].
Ljung BO, Forsgren S, Fridén J. Substance P and calcitonin gene-related peptide expression at the extensor carpi radialis brevis muscle origin: implications for the etiology of tennis elbow. J Orthop Res. Jul 1999;17(4):554-9. [Medline].
Hannah GA, Whiteside JA. The elbow in athletics. Sports Medicine Secrets. Philadelphia, Pa: Hanley & Belfus; 1994:249-55.
Vicenzino B, Brooksbank J, Minto J, Offord S, Paungmali A. Initial effects of elbow taping on pain-free grip strength and pressure pain threshold. J Orthop Sports Phys Ther. Jul 2003;33(7):400-7. [Medline].
Assendelft WJ, Hay EM, Adshead R, Bouter LM. Corticosteroid injections for lateral epicondylitis: a systematic overview. Br J Gen Pract. Apr 1996;46(405):209-16. [Medline]. [Full Text].
Klaiman MD, Shrader JA, Danoff JV, et al. Phonophoresis versus ultrasound in the treatment of common musculoskeletal conditions. Med Sci Sports Exerc. Sep 1998;30(9):1349-55. [Medline].
Baskurt F, Ozcan A, Algun C. Comparison of effects of phonophoresis and iontophoresis of naproxen in the treatment of lateral epicondylitis. Clin Rehabil. Feb 2003;17(1):96-100. [Medline].
Nirschl RP, Rodin DM, Ochiai DH, Maartmann-Moe C, and the DEX-AHE-01-99 Study Group. Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis. A randomized, double-blinded, placebo-controlled study. Am J Sports Med. Mar-Apr 2003;31(2):189-95. [Medline].
Stanley KL, Weaver JE. Pharmacologic management of pain and inflammation in athletes. Clin Sports Med. Apr 1998;17(2):375-92. [Medline].
Burnham R, Gregg R, Healy P, Steadward R. The effectiveness of topical diclofenac for lateral epicondylitis. Clin J Sport Med. Apr 1998;8(2):78-81. [Medline].
Labelle H, Guibert R. Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with immobilization. The University of Montreal Orthopaedic Research Group. Arch Fam Med. May-Jun 1997;6(3):257-62. [Medline].
Quillen WS, Magee DJ, Zachazewski JE. The process of athletic injury and rehabilitation. In: Athletic Injuries and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996:3-8.
Thurston AJ. Conservative and surgical treatment of tennis elbow: a study of outcome. Aust N Z J Surg. Aug 1998;68(8):568-72. [Medline].
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].
Verhaar JA, Walenkamp GH, van Mameren H, et al. Local corticosteroid injection versus Cyriax-type physiotherapy for tennis elbow. J Bone Joint Surg Br. Jan 1996;78(1):128-32. [Medline].
Pfenninger JL. Joint and soft tissue aspiration and injection. Procedures for Primary Care Physicians. St Louis, Mo: Mosby; 1994:1036-54.
Suresh SP, Ali KE, Jones H, Connell DA. Medial epicondylitis: is ultrasound guided autologous blood injection an effective treatment?. Br J Sports Med. Nov 2006;40(11):935-9; discussion 939. [Medline].
Connell DA, Ali KE, Ahmad M, et al. Ultrasound-guided autologous blood injection for tennis elbow. Skeletal Radiol. Jun 2006;35(6):371-7. [Medline].
Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg [Am]. Mar 2003;28(2):272-8. [Medline].
Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. Feb 2010;38(2):255-62. [Medline].
Keizer SB, Rutten HP, Pilot P, et al. Botulinum toxin injection versus surgical treatment for tennis elbow: a randomized pilot study. Clin Orthop Relat Res. Aug 2002;401:125-31. [Medline].
Rompe JD, Hope C, Küllmer K, Heine J, Bürger R. Analgesic effect of extracorporeal shock-wave therapy on chronic tennis elbow. J Bone Joint Surg Br. Mar 1996;78(2):233-7. [Medline]. [Full Text].
Speed CA, Nichols D, Richards C, et al. Extracorporeal shock wave therapy for lateral epicondylitis--a double blind randomised controlled trial. J Orthop Res. Sep 2002;20(5):895-8. [Medline].
Haake M, König IR, Decker T, et al. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis : a randomized multicenter trial. J Bone Joint Surg Am. Nov 2002;84-A(11):1982-91. [Medline].
Melikyan EY, Shahin E, Miles J, Bainbridge LC. Extracorporeal shock-wave treatment for tennis elbow. A randomised double-blind study. J Bone Joint Surg Br. Aug 2003;85(6):852-5. [Medline].
Chung B, Wiley JP. Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis: a randomized controlled trial. Am J Sports Med. Oct-Nov 2004;32(7):1660-7. [Medline].
Mehra A, Zaman T, Jenkin AI. The use of a mobile lithotripter in the treatment of tennis elbow and plantar fasciitis. Surgeon. Oct 2003;1(5):290-2. [Medline].
Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med. Nov-Dec 2003;31(6):915-20. [Medline].
Ciccotti MC, Schwartz MA, Ciccotti MG. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med. Oct 2004;23(4):693-705, xi. [Medline].
McCarthy D. Nonsteroidal anti-inflammatory drug-related gastrointestinal toxicity: definitions and epidemiology. Am J Med. Nov 2 1998;105(5A):3S-9S. [Medline].
Wang AA, Whitaker E, Hutchinson DT, Coleman DA. Pain levels after injection of corticosteroid to hand and elbow. Am J Orthop. Aug 2003;32(8):383-5. [Medline].

