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Medial Epicondylitis

(Golfer's Elbow)
  • Definition

    Medial epicondylitis is pain over the bone on the inner side of the elbow. The piece of bone that can be felt on the inner side of the elbow is called the medial epicondyle. When the tendons attached to this bone are overstretched or torn, they can become painful. This is called tendinopathy.
    Medial epicondylitis is commonly called golfer's elbow, but it is not restricted to people who play golf. It can occur in tennis players and other people who repeatedly grip objects tightly.
    Medial Epicondylitis
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    Copyright © Nucleus Medical Media, Inc.
  • Causes

    Golfer's elbow is caused by overusing the flexor muscles of the forearms. Overusing these muscles can stretch or tear the tendons attached to the medial epicondyle.
    Causes include:
    • Improper golf swing technique or grip of golf clubs
    • Wrong model of golf clubs
    • Improper technique for hitting a tennis ball
    • Improper size of tennis racquet or tension of racquet strings
    • Doing certain arm motions too much, such as:
      • Golf swings
      • Tennis strokes (forehand or serve)
      • Painting
      • Raking
      • Pitching
      • Rowing
      • Using a hammer or screwdriver
  • Risk Factors

    Factors that may increase your chance of medial epicondylitis include:
    • Playing golf or tennis
    • Work that requires repetitive gripping or clenching of the fingers (especially when the hand is bent up or down at the wrist)
    • Muscle imbalance
    • Decreased flexibility
    • Advancing age
  • Symptoms

    Symptoms include:
    • Pain or tenderness on the inner side of the elbow
    • Pain increases when:
      • Shaking hands
      • Turning doorknobs
      • Picking up objects with your palm down
      • Hitting a forehand in tennis
      • Swinging a golf club
      • Applying pressure to this area
    • Possibly pain extending down the forearm
    • Tightness of forearm muscles
    • Stiffness or trouble moving the elbow or hand
  • Diagnosis

    The doctor will ask about your symptoms, medical history, recent physical activity, and how the injury occurred. You may not remember the event that caused the injury because golfer's elbow pain develops over time. The doctor will examine your elbow for:
    • Pain on the inner side of the elbow when:
      • Doing certain arm motions
      • Pressing on the medial epicondyle
    • Stiffness of elbow and pain with wrist movement
    X-rays are not usually necessary. However, an x-ray may be needed if the doctor suspects other problems.
    An MRI scan is occasionally used for diagnosis, but there is only limited evidence supporting this use.
  • Treatment

    Treatment includes:
    Rest
    Do not do activities that cause pain. Do not play sports, especially golf and tennis, until the pain is gone. You may need to alter how you do certain activities.
    Cold
    Regular ice application may help decrease some discomfort and swelling.
    Medication
    The following drugs can help to reduce inflammation and pain:
    • Nonsteroid anti-inflammatory drugs (NSAIDs)
    • Acetaminophen
    • Topical pain relievers that are applied to the skin
    If you still have tenderness in the elbow while taking these drugs, do not return to physical activity. Check with your doctor.
    Compression
    Wear a counter-force brace on your forearm if recommended by your healthcare professional. This brace limits the force generated by your forearm muscles when you use them.
    Heat
    Apply heat to the elbow only when you are returning to physical activity. Then use it before stretching or getting ready to play sports.
    Stretching
    When the acute pain is gone, start gentle stretching as recommended by a healthcare professional. Stay within pain limits. Hold each stretch for about 10 seconds and repeat 6 times.
    Strengthening
    Begin strengthening exercises for the flexor muscles of the forearm as recommended.
    Gradual Return to Your Sport
    Begin arm motions of your sport or activity (such as golf swings, tennis strokes, painting) as recommended.
    Cortisone Injection
    The doctor may inject cortisone into the elbow near the medial epicondyle to reduce pain and inflammation.
  • Prevention

    To help reduce your chance of medial epicondylitis:
    • Keep your arm muscles strong so they can absorb the energy of sudden physical stress.
    • After a short warm-up period, stretch your arm muscles before physical activity.
    • Learn the proper technique for activities that require forearm motion.
    • If you play golf, ask a golf specialist to check your:
      • Swing technique
      • Grip
      • Model of golf clubs
    • If you play tennis, ask a tennis specialist to check your:
      • Technique for hitting a forehand
      • Racket size and tension of racket strings
  • RESOURCES

    Ortho Info— American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

    Sports Med—American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org

    References

    Chumbley EM, O'Connor FG. Evaluation of overuse elbow injuries. Am Fam Physician. 2000;61(3):691-700.

    Golf injury prevention. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00137. Updated August 2011. Accessed December 17, 2014.

    Józsa LG, Kannus P. Human tendons. Human Kinetics; 1997.

    Medial epicondylitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 20, 2014. Accessed December 17, 2014.

    Metz JP. Managing golf injuries: Technique and equipment changes that aid treatment. Phys Sportsmed. 1999;27(7):41-56.

    Overuse injuries. American Orthopaedic Society for Sports Medicine website. Available at: http://www.sportsmed.org/downloads/tips/AOSSM%5FOveruse%20Injuries.pdf. Accessed December 17, 2014.

    Petersen B, Rovati S. Diclofenac epolamine (Flector) patch: Evidence for topical activity. Clin Drug Investig. 2009;29(1):1-9.

    Shiri R, Viikari-Juntura E. Lateral and medial epicondylitis: Role of occupational factors. Best Pract Res Clin Rheumatol. 2011;25(1):43-57.

    10/26/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Massey T, Derry S, et al. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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