History

The most common symptom that patients report with medial epicondylitis (golfer's elbow) 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.

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 instability of the ulnar (medial) collateral ligament (UCL) or the radial (lateral) collateral ligament (RCL).^[21] Surgery is contraindicated in the presence of any ligamentous instability.

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.^[22]

Workup

Morris HJ. Rider's sprain. Lancet. 1882. 2:557.
McHardy A, Pollard H, Luo K. One-year follow-up study on golf injuries in Australian amateur golfers. Am J Sports Med. 2007 Aug. 35 (8):1354-60. [QxMD MEDLINE Link].
Galloway M, DeMaio M, Mangine R. Rehabilitative techniques in the treatment of medial and lateral epicondylitis. Orthopedics. 1992 Sep. 15 (9):1089-96. [QxMD MEDLINE Link].
Nordander C, Ohlsson K, Akesson I, Arvidsson I, Balogh I, Hansson GA, et al. Risk of musculoskeletal disorders among females and males in repetitive/constrained work. Ergonomics. 2009 Oct. 52 (10):1226-39. [QxMD MEDLINE Link].
van Rijn RM, Huisstede BM, Koes BW, Burdorf A. Associations between work-related factors and specific disorders at the elbow: a systematic literature review. Rheumatology (Oxford). 2009 May. 48 (5):528-36. [QxMD MEDLINE Link].
Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006 Dec 1. 164 (11):1065-74. [QxMD MEDLINE Link].
Nirschl R. Medial epicondylitis/tendinosis. Morrey BF, Sanchez-Sotelo J, Morrey ME, eds. Morrey's The Elbow and Its Disorders. 5th ed. Philadelphia: Elsevier; 2018. 588-94.
Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg. 2015 Jun. 23 (6):348-55. [QxMD MEDLINE Link].
Dellon AL, MacKinnon SE. Injury to the medial antebrachial cutaneous nerve during cubital tunnel surgery. J Hand Surg Br. 1985 Feb. 10 (1):33-6. [QxMD MEDLINE Link].
Putnam MD, Cohen M. Painful conditions around the elbow. Orthop Clin North Am. 1999 Jan. 30 (1):109-18. [QxMD MEDLINE Link].
Nirsch RP. Letter: Etiology of tennis elbow. J Sports Med. 1975 Sep-Oct. 3 (5):261-3. [QxMD MEDLINE Link].
Zeisig E, Ljung BO, Alfredson H, Danielson P. Immunohistochemical evidence of local production of catecholamines in cells of the muscle origins at the lateral and medial humeral epicondyles: of importance for the development of tennis and golfer's elbow?. Br J Sports Med. 2009 Apr. 43 (4):269-75. [QxMD MEDLINE Link].
Plancher KD, Halbrecht J, Lourie GM. Medial and lateral epicondylitis in the athlete. Clin Sports Med. 1996 Apr. 15 (2):283-305. [QxMD MEDLINE Link].
Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Occupation and epicondylitis: a population-based study. Rheumatology (Oxford). 2012 Feb. 51 (2):305-10. [QxMD MEDLINE Link].
Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011 Feb. 25 (1):43-57. [QxMD MEDLINE Link].
Cho BK, Kim YM, Kim DS, Choi ES, Shon HC, Park KJ, et al. Mini-open muscle resection procedure under local anesthesia for lateral and medial epicondylitis. Clin Orthop Surg. 2009 Sep. 1 (3):123-7. [QxMD MEDLINE Link]. [Full Text].
Shahid M, Wu F, Deshmukh SC. Operative treatment improves patient function in recalcitrant medial epicondylitis. Ann R Coll Surg Engl. 2013 Oct. 95 (7):486-8. [QxMD MEDLINE Link].
Han SH, Lee JK, Kim HJ, Lee SH, Kim JW, Kim TS. The result of surgical treatment of medial epicondylitis: analysis with more than a 5-year follow-up. J Shoulder Elbow Surg. 2016 Oct. 25 (10):1704-9. [QxMD MEDLINE Link].
Arevalo A, Rao S, Willier DP 3rd, Schrock CI, Erickson BJ, Jack RA 2nd, et al. Surgical Techniques and Clinical Outcomes for Medial Epicondylitis: A Systematic Review. Am J Sports Med. 2022 Jun 6. 3635465221095565. [QxMD MEDLINE Link].
McCarroll JR. Overuse injuries of the upper extremity in golf. Clin Sports Med. 2001 Jul. 20 (3):469-79. [QxMD MEDLINE Link].
Richard MJ, Aldridge JM 3rd, Wiesler ER, Ruch DS. Traumatic valgus instability of the elbow: pathoanatomy and results of direct repair. Surgical technique. J Bone Joint Surg Am. 2009 Oct 1. 91 Suppl 2:191-9. [QxMD MEDLINE Link].
Weiss LD, Weiss JM. Medial epicondylitis. Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia: Elsevier; 2019. 128-30.
Schwab GH, Bennett JB, Woods GW, Tullos HS. Biomechanics of elbow instability: the role of the medial collateral ligament. Clin Orthop Relat Res. 1980 Jan-Feb. 146:42-52. [QxMD MEDLINE Link].
Bae KJ, Park C, Ahn JM, Kang Y, Gong HS. Magnetic resonance imaging evaluation of patients with clinically diagnosed medial Epicondylitis. Skeletal Radiol. 2021 Aug. 50 (8):1629-1636. [QxMD MEDLINE Link].
Miller TT. Imaging of elbow disorders. Orthop Clin North Am. 1999 Jan. 30 (1):21-36. [QxMD MEDLINE Link].
Park GY, Lee SM, Lee MY. Diagnostic value of ultrasonography for clinical medial epicondylitis. Arch Phys Med Rehabil. 2008 Apr. 89 (4):738-42. [QxMD MEDLINE Link].
Shin M, Hahn S, Yi J, Lim YJ, Bang JY. Clinical Application of Real-Time Sonoelastography for Evaluation of Medial Epicondylitis: A Pilot Study. Ultrasound Med Biol. 2019 Jan. 45 (1):246-254. [QxMD MEDLINE Link].
Bang JY, Hahn S, Yi J, Lim YJ, Jung HK. Clinical applicability of shear wave elastography for the evaluation of medial epicondylitis. Eur Radiol. 2021 Sep. 31 (9):6726-6735. [QxMD MEDLINE Link].
Ellenbecker TS, Davies GJ. Lateral and medial humeral epicondylitis. Giangarra CE, Manske RC, Brotzman SB, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia: Elsevier; 2018. 81-8.
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. 1997 Nov. 79 (11):1648-52. [QxMD MEDLINE Link].
Krischek O, Hopf C, Nafe B, Rompe JD. Shock-wave therapy for tennis and golfer's elbow--1 year follow-up. Arch Orthop Trauma Surg. 1999. 119 (1-2):62-6. [QxMD MEDLINE Link].
Rogers S, Eberle B, Vogt DR, Meier E, Moser L, Gomez Ordoñez S, et al. Prospective Evaluation of Changes in Pain Levels, Quality of Life and Functionality After Low Dose Radiotherapy for Epicondylitis, Plantar Fasciitis, and Finger Osteoarthritis. Front Med (Lausanne). 2020. 7:195. [QxMD MEDLINE Link]. [Full Text].
Bohlen HL, Schwartz ZE, Wu VJ, Thon SG, Finley ZJ, O'Brien MJ, et al. Platelet-Rich Plasma Is an Equal Alternative to Surgery in the Treatment of Type 1 Medial Epicondylitis. Orthop J Sports Med. 2020 Mar. 8 (3):2325967120908952. [QxMD MEDLINE Link]. [Full Text].
Gabel GT, Morrey BF. Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow. J Bone Joint Surg Am. 1995 Jul. 77 (7):1065-9. [QxMD MEDLINE Link]. [Full Text].
Zonno A, Manuel J, Merrell G, Ramos P, Akelman E, DaSilva MF. Arthroscopic technique for medial epicondylitis: technique and safety analysis. Arthroscopy. 2010 May. 26 (5):610-6. [QxMD MEDLINE Link].
do Nascimento AT, Claudio GK. Arthroscopic surgical treatment of medial epicondylitis. J Shoulder Elbow Surg. 2017 Dec. 26 (12):2232-2235. [QxMD MEDLINE Link].
Kwon BC, Kwon YS, Bae KJ. The Fascial Elevation and Tendon Origin Resection Technique for the Treatment of Chronic Recalcitrant Medial Epicondylitis. Am J Sports Med. 2014 Jul. 42 (7):1731-7. [QxMD MEDLINE Link].
Tasto JP, Richmond JM, Cummings JR, Hardesty R, Amiel D. Radiofrequency Microtenotomy for Elbow Epicondylitis: Midterm Results. Am J Orthop (Belle Mead NJ). 2016 Jan. 45 (1):29-33. [QxMD MEDLINE Link]. [Full Text].
Wu VJ, Thon S, Finley Z, Bohlen H, Schwartz Z, O'Brien MJ, et al. Double-Row Repair for Recalcitrant Medial Epicondylitis. Orthop J Sports Med. 2019 Dec. 7 (12):2325967119885608. [QxMD MEDLINE Link]. [Full Text].
Lee JH, Kim DH, Lee SH, Hwang JH, Cho SB, Kim M, et al. Short-term Results of Transcatheter Arterial Embolization for Chronic Medial Epicondylitis Refractory to Conservative Treatment: A Single-Center Retrospective Cohort Study. Cardiovasc Intervent Radiol. 2022 Feb. 45 (2):197-204. [QxMD MEDLINE Link].

Media Gallery

Medial epicondyle.

of 1

Author

Lacie Alfonso, MD Medical Director, The Rehabilitation Center at Dauterive Hospital

Lacie Alfonso, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen Kishner, MD, MHA Clinical Professor, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

James Monroe Laborde, MD, MS Clinical Assistant Professor, Department of Orthopedics, Louisiana State University Health Sciences Center and Tulane Medical School; Board of Advisors, Department of Biomedical Engineering, Tulane University; Adjunct Assistant Professor, Department of Physical Medicine and Rehabilitation, Louisiana State University Medical School

James Monroe Laborde, MD, MS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert J Nowinski, DO Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Ohio State Medical Association, Ohio Osteopathic Association, American College of Osteopathic Surgeons, American Osteopathic Association

Disclosure: Received grant/research funds from Tornier for other; Received honoraria from Tornier for speaking and teaching.

Chief Editor

Murali Poduval, MBBS, MS, DNB Orthopaedic Surgeon, Senior Consultant, and Subject Matter Expert, Tata Consultancy Services, Mumbai, India

Murali Poduval, MBBS, MS, DNB is a member of the following medical societies: Association of Medical Consultants of Mumbai, Bombay Orthopedic Society, Indian Orthopedic Association, Indian Society of Hip and Knee Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Steven I Rabin, MD, FAAOS Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Musculoskeletal Services, Dreyer Medical Clinic

Steven I Rabin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Fracture Association, American Orthopaedic Association, AO Foundation, Chicago Metropolitan Trauma Society, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society, Mid-America Orthopaedic Association, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Sections Surgery for Medial Epicondylitis (Golfer's Elbow)
Overview
Presentation
Workup
Treatment
References

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

History

Physical Examination

Complications

References

Tables

Contributor Information and Disclosures

What would you like to print?