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Medial Epicondylitis - Golfer's elbow

Golfer's elbow is a common term used for medial epicondylitis. Medial epicondylitis is clinically defined as pain at the medial epicondyle due to repetitive flexion and pronation at the elbow.
 
Symptoms
There is gradual onset of exercise induced pain around the medial epicondyle of the elbow that is aggravated by hyper-extension.
This is an over-use type injury of unknown etiology, often affecting the wrist flexor muscle origins at the medial epicondyle in racket sports players, javelin throwers and cricket bowlers. Despite the name, such injury to golfers is rare.


Clinical Findings
There is tenderness on palpation over the medial humerus epicondyle and pain and weakness is caused by resisted elbow hyper-extension.

Medial epicondylitis anatomy
Medial epicondylitis anatomy

Treatment

  • Initial treatment includes relative rest, ice, acetaminophen or NSAIDs.
  • The mainstay of treatment includes stretching and strengthening exercises with progression to eccentric training exercise with or without formal physical therapy.
  • Bracing is also helpful.
  • If no improvement in 6 wks, consider obtaining x-rays and initiating formal physical therapy.
  • If still symptomatic corticosteroid injections may be considered.
  • If symptoms persist, consider advanced imaging with US or MRI to confirm diagnosis.
  • Rarely, refractory symptoms above 6 months in duration may require surgical intervention.

Exercise Prescription

Many sports can be maintained during healing but the duration of symptoms is usually long. Running, cycling and swimming are good alternatives to keep up general fitness. Gym training can be maintained.