Physical Medicine and Rehabilitation for Epicondylitis Clinical Presentation

Updated: Feb 07, 2023
  • Author: Sharon J Gibbs, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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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.



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.



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). [7]

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