Medial epicondylitis is inflammation of the flexor pronator muscle mass originating at the medial epicondyle of the elbow. Diagnosis is with provocative testing. Treatment is rest and ice followed by exercises and gradual return to activity.
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
Primarily history and physical examination
Provocative testing
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.)
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. Patients should avoid any activity that causes pain. Initially, rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching are used (1), occasionally with a glucocorticoid injection into the painful area around the tendon. When pain subsides, gentle resistive exercises of the extensor and flexor muscles of the forearm are performed, followed by eccentric and concentric resistive exercises. In general, surgery is considered only after at least 9 to 12 months of failed nonsurgical management (1). Surgical techniques to treat medial epicondylitis involve removing scar tissue and reattaching damaged tissues.
1. Flatten putty on table.
2. Flex (curl) fingers and place on putty.
3. Extend and abduct (spread) fingers.
4. Perform
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. Perform 3 sets of
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. Place forearm on table with the hand palm up, off the edge of the table.
2. Curl wrist up into flexion.
3. Slowly lo
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. Begin with the elbow straight.
2. With the uninvolved hand, grasp thumb side of hand and bend wrist downward into wr
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. Flex (curl) fingers and place on putty.
3. Extend and abduct (spread) fingers.
4. Perform 3 sets of 10 repetitions, 1 time a day.
5. Special Instructions
a. Start with least resistance putty (ie, yellow).
b. Can also perform exercise using rubber band for resistance around fingers.
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. Perform 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. 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. Perform 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 least resistance (ie, a soup can) or simply against gravity.
c. Can also perform 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. Place forearm on table with the hand palm up, off the edge of the table.
2. Curl wrist up into flexion.
3. Slowly lower and extend wrist to starting position.
4. Perform 3 sets of 10 repetitions, 1 time a day.
5. Special Instructions
a. Focus on lowering (eccentric) phase with a count of 4 to extend wrist down to starting position and a count of 2 up for wrist flexion.
b. Start with light resistance (ie, a soup can) or simply against gravity.
c. Can also perform 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. 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 exercise for 30 seconds.
6. Perform 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. Begin with the elbow straight.
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 exercise for 30 seconds.
5. Perform 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.
Treatment reference
1. Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg. 2015;23(6):348-355. doi:10.5435/JAAOS-D-14-00145
