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.
Physical
Tenderness with palpation over the anterior aspect of the medial epicondyle is the most consistent finding. Other characteristics of ME include the following:
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Typically, pain is reproduced with resisted wrist flexion or resisted forearm pronation.
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Occasionally, the area of tenderness extends approximately 1 inch toward the proximal flexor-pronator muscle mass just distal to the epicondyle.
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The range of motion of the elbow and wrist is usually within normal limits.
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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.
Causes
The causes of ME include the following:
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The condition can result from the repetitive use of flexor-pronator muscles, especially with valgus stress at the medial epicondyle.
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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]
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ME's onset can accompany acute injury.
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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.
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Medial epicondyle.
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Strengthening exercises are performed once pain has subsided with active range of motion. The starting position (slight pronation) of an eccentric exercise for medial epicondylitis is shown. In order to prevent further injury, a trained therapist should instruct patients in exercises to confirm proper weight and technique.
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The eccentric exercise proceeds until full supination has been reached.
