eMedicine Specialties > Sports Medicine > Upper Limb

Medial Epicondylitis

Author: Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Contributor Information and Disclosures

Updated: Jan 22, 2008

Introduction

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.

Related eMedicine topics:
Elbow and Forearm Overuse Injuries
Lateral Epicondylitis
Little League Elbow Syndrome
Medial Epicondylitis [in the Physical Medicine and Rehabilitation section]
Medial Epicondylitis [in the Orthopedic Surgery section]
Overuse Injury
Tendonitis

Related Medscape topics:
Resource Center Exercise and Sports Medicine
CME Guidelines Issued for Overuse Injuries in Child and Adolescent Athletes
CME Medical Interventions Effectively Treat Overuse Injuries in Adult Endurance Athletes
Imaging of Elbow Pathology

Frequency

United States

Medial epicondylitis accounts for only 10-20% of all epicondylitis diagnoses1 ; 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.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

Clinical

History

  • Athletes generally complain of aching pain over the medial elbow. Patients who have more chronic pain may also complain of grip weakness.8
  • Pain may be associated with the acceleration phase of throwing.
  • Ulnar nerve symptoms are associated in up to 20% of athletes with medial epicondylitis.2

Related Medscape topics:
Resource Center Pain Management: Advanced Approaches to Chronic Pain Management
Resource Center Pain Management: Pharmacologic Approaches

Physical

  • On physical examination, the athlete experiences pain with resisted wrist flexion, and there is palpable tenderness over the medial epicondyle. Pain is also frequently found with resisted forearm pronation.
  • In more chronic cases of medial epicondylitis, there may be pain with resisted elbow flexion.
  • The Tinel sign should be checked over the ulnar nerve to rule out ulnar neuropathy.
  • Remember to examine the UCL, especially in baseball players. Chronic UCL deficiency is more common than medial epicondylitis in throwing athletes. However, because the origins of the flexor mass and the UCL are relatively close together, both chronic UCL deficiency and medial epicondylitis may present with medial elbow pain. A magnetic resonance imaging (MRI) study may be useful in differentiating these injuries, if they are not clinically apparent.
Related eMedicine topic:
Ulnar Collateral Ligament Injury [in the Sports Medicine section]

Causes

  • Training errors: These errors may increase the risk of developing medial epicondylitis. Athletes usually have a history of increased intensity or duration of activity, and they may not warm up adequately.
  • Improper technique: This is one of the major causes of medial epicondylitis. Tennis players with poor serves and forehand strokes are at greater risk of developing medial epicondylitis.1
  • Equipment: The use of an incorrectly sized tennis racquet grip, overly tightened racquet strings, older tennis balls, and wet tennis balls may increase elbow stress. The use of graphite racquets and larger headed racquets can decrease elbow stress.1
  • Functional risk factors: Weakness, poor endurance, and poor flexibility of the forearm may increase the risk of developing medial epicondylitis.

More on Medial Epicondylitis

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

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Further Reading

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Keywords

golfer's elbow, little leaguer's elbow, overuse tendinopathy

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Contributor Information and Disclosures

Author

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Anthony J Saglimbeni, MD, Staff Physician, Family Practice Residency, Medical Director, Center for Sports Medicine, O'Connor Hospital; Private Practice
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

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