Physical Medicine and Rehabilitation for Epicondylitis Clinical Presentation

Updated: Aug 30, 2018
  • Author: Sharon J Gibbs, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Presentation

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.

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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.

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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). [5]

  • 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 [6] are common sports-related causes of ME.

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