Medial epicondylitis is caused by any activity that places a valgus force on the elbow or that involves forcefully flexing the volar forearm muscles, as occurs during pitching, golfing with improper technique, serving a tennis ball (particularly with top spin, with a racket that is too heavy or too tightly strung or has an undersized grip, or with heavy balls), and throwing a javelin. Nonathletic activities that may cause medial epicondylitis include bricklaying, hammering, and typing.
Symptoms and Signs of Medial Epicondylitis
Pain occurs in the flexor pronator tendons (attached to the medial epicondyle) and in the medial epicondyle when the wrist is flexed or pronated against resistance.
Diagnosis of Medial Epicondylitis
To confirm the diagnosis, the examiner has the patient sit in a chair with the forearm resting on a table and the hand supinated. The patient tries to raise the fist by bending the wrist while the examiner holds it down. Pain around the medial epicondyle and in the flexor tendon origin confirms the diagnosis. (See also How to Examine the Elbow Evaluation of the Elbow An evaluation of the elbow includes a physical examination and sometimes arthrocentesis. (See also Evaluation of the Patient With Joint Symptoms.) Synovial swelling and thickening caused by... read more .)
Treatment of Medial Epicondylitis
Rest, ice, and muscle stretches
Modification of activity
Later, resistive exercises
Treatment is symptomatic and similar to that of lateral epicondylitis Treatment Lateral epicondylitis results from inflammation and microtearing of fibers in the extensor tendons of the forearm. Symptoms include pain at the lateral epicondyle of the elbow, which can radiate... read more . Patients should avoid any activity that causes pain. Initially, rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching are used, occasionally with a corticosteroid injection into the painful area around the tendon. When pain subsides, gentle resistive exercises of the extensor and flexor muscles of the forearm are done, followed by eccentric and concentric resistive exercises. In general, surgery is considered only after at least 9 to 12 months of failed conservative management. Surgical techniques to treat medial epicondylitis involve removing scar tissue and reattaching damaged tissues.