History

Athletes generally complain of aching pain over the medial elbow. Patients who have more chronic pain may also complain of grip weakness.^[11]

Pain may be associated with the acceleration phase of throwing.

Ulnar nerve symptoms are associated in up to 20% of athletes with medial epicondylitis.^[5]

Physical

On physical examination, the athlete experiences pain with resisted wrist flexion, and there is palpable tenderness over the medial epicondyle. Pain is also frequently found with resisted forearm pronation.

In more chronic cases of medial epicondylitis, there may be pain with resisted elbow flexion.

The Tinel sign should be checked over the ulnar nerve to rule out ulnar neuropathy.

Remember to examine the UCL, especially in baseball players. Chronic UCL deficiency is more common than medial epicondylitis in throwing athletes. However, because the origins of the flexor mass and the UCL are relatively close together, both chronic UCL deficiency and medial epicondylitis may present with medial elbow pain. A magnetic resonance imaging (MRI) study may be useful in differentiating these injuries, if they are not clinically apparent.

A study by Vinod et al found that pronation weakness at 90° is a reliable physical examination finding for determining clinically significant pathologic changes in patients with medial epicondylitis.^[12]

Causes

See the list below:

Training errors: These errors may increase the risk of developing medial epicondylitis. Athletes usually have a history of increased intensity or duration of activity, and they may not warm up adequately.
Improper technique: This is one of the major causes of medial epicondylitis. Tennis players with excessive top spin, poor serves and forehand strokes are at greater risk of developing medial epicondylitis.^[1]
Equipment: The use of an incorrectly sized tennis racquet grip, overly tightened racquet strings, older tennis balls, and wet tennis balls may increase elbow stress. The use of graphite racquets and larger headed racquets can decrease elbow stress.^{[1, 2]}
Functional risk factors: Weakness, poor endurance, and poor flexibility of the forearm may increase the risk of developing medial epicondylitis.

Differential Diagnoses

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