Medial epicondylitis is inflammation of the tendons of the muscles that flex or bend the palm toward the wrist, causing pain on the inner part of the elbow and forearm.
(See also Overview of Sports Injuries.)
An activity involving repeated stressful bending of the wrist toward the palm is the usual cause.
Rest, ice, and analgesics help relieve pain.
When pain subsides, stretching and strengthening exercises are done to help prevent recurrence.
This injury is caused by bending the wrist against resistance toward the palm repetitively (see figure When the Elbow Hurts). Some actions that can cause this injury include serving with great force in tennis; using an overhand and a top spin serve; hitting heavy, wet balls; using a racket that is too heavy or that has a grip that is too small or has strings that are too tight; pitching a baseball; and throwing a javelin. Poor technique when hitting the ball in golf can cause this inflammation as well—hence the term golfer’s elbow. Injury occurs when “hitting from the top” and is basically forcefully bringing the club with the right arm (right-handed golfer) down from the top of the swing, placing extreme stress on the flexor muscles of the right elbow instead of pulling down the club with the left arm and the body. Nonathletic activities that may cause medial epicondylitis include bricklaying, hammering, and typing.
Pain is felt on the inner part of the elbow and forearm. It is worse when the palm moves toward the wrist.
Diagnosis of Medial Epicondylitis
A doctor's evaluation
Doctors make the diagnosis based on the symptoms and results of an examination. The doctor asks the person to sit in a chair with the injured arm resting on a table, palm up. The doctor holds the wrist down and asks the person to raise the hand by bending the wrist. A person who has medial epicondylitis feels pain at the inner part of the elbow.
Treatment of Medial Epicondylitis
Rest
Rehabilitation
Initial treatment includes avoiding any activity that causes pain when the wrist is bent toward the palm. Ice applied over the painful area and nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve pain. After pain has decreased, an exercise program that strengthens the wrist and shoulder muscles is begun. Surgery is rarely needed.
1. Begin with the elbow straight, palm down.
2. With the uninvolved hand, grasp thumb side of hand and bend wrist downw
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Position involved hand palm up.
2. Grasp fingers on involved hand with the other hand.
3. Keep elbow straight on inv
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Place forearm on table with the hand palm down, off the edge of the table.
2. Move wrist up into extension.
3. Slowl
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Grasp and gently squeeze towel roll with both hands.
2. Twist towel in alternating directions.
3. Do 3 sets of 10 r
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Flatten putty on table.
2. Curl (flex) fingers and place on putty.
3. Straighten and spread fingers, pushing into pu
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Begin with the elbow straight, palm down.
2. With the uninvolved hand, grasp thumb side of hand and bend wrist downward into wrist flexion.
3. To increase the stretch, bend wrist toward small finger and pull, curling fingers into more flexion.
4. Hold each stretch for 30 seconds.
5. Do 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Position involved hand palm up.
2. Grasp fingers on involved hand with the other hand.
3. Keep elbow straight on involved arm.
4. Pull hand and fingers gently into extension.
5. Hold stretch for 30 seconds.
6. Do 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Place forearm on table with the hand palm down, off the edge of the table.
2. Move wrist up into extension.
3. Slowly flex wrist down to starting position.
4. Do 3 sets of 10 repetitions, 1 time a day.
5. Special instructions
a. Focus on lowering (eccentric) phase with a count of 4 to flex wrist down to starting position and a count of 2 up for wrist extension.
b. Start with light weight (for example, a soup can) or no weight.
c. Can also do exercise with band resistance.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Grasp and gently squeeze towel roll with both hands.
2. Twist towel in alternating directions.
3. Do 3 sets of 10 repetitions, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Flatten putty on table.
2. Curl (flex) fingers and place on putty.
3. Straighten and spread fingers, pushing into putty.
4. Do 3 sets of 10 repetitions, 1 time a day.
5. Special instructions
a. Start with lowest resistance putty (that is, yellow).
b. Can also do exercise using rubber band around fingers for resistance.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
