Surgery for Medial Epicondylitis (Golfer's Elbow) Clinical Presentation

Updated: Aug 19, 2020
  • Author: Lacie Alfonso, MD; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
  • Print
Presentation

History

The most common symptom that patients report with medial epicondylitis is achy pain over the anterior medial epicondyle, usually during activity, and the patient may describe weakness in the forearm or hand. In addition, radiation of the pain may occur in the shoulder, forearm, or hand. To evaluate and diagnose this condition, the patient should be questioned regarding trauma, medical, and surgical history; medications; sensory symptoms; and duration and frequency of symptoms.

Next:

Physical Examination

Begin the examination with inspection of the medial aspect of the affected elbow. Proceed with palpation of the medial and lateral epicondyles, olecranon, brachial pulse, olecranon fossa, capitellum, and radial head. Finally, palpate the triceps, biceps, and flexor and extensor muscles. Palpate the ulnar nerve in the ulnar groove while the patient flexes the arm. In some patients, the ulnar nerve will sublux out of the groove medially over the medial epicondyle.

Clinical diagnosis of medial epicondylitis should be considered if tenderness to palpation is present over the anterior aspect of the medial epicondyle. Some patients may have tenderness just distal to the medial epicondyle over the flexor-pronator tendinous bands. The affected elbow's range of motion (ROM) should be normal.

The neurologic examination, including motor, sensory, and reflex testing, is very important for excluding cervical radiculopathy and ulnar neuropathy. Evaluate for a Tinel sign between the olecranon and the medial epicondyle to detect ulnar neuropathy (ie, lightly tapping on the nerve exacerbates the patient's symptoms and/or results in a tingling paresthesia). Pain over the medial epicondyle should be worse with resisted wrist flexion and pronation.

Valgus and varus stress testing should be performed to evaluate for ulnar and radial collateral ligament instability [20] . Surgery is contraindicated in the presence of any ligamentous instability.

Previous
Next:

Complications

Recognizing and treating medial epicondylitis in the acute stage is very important. The long-term complications of the untreated condition include chronic pain, loss of function, and possible elbow contracture. [21]

Previous