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CONDITION/DISORDER SYNONYMS

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  • Medial tendon injury

  • Medial tendonitis

  • Golfer’s elbow

  • Bowler’s elbow

  • Little leaguer’s elbow

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ICD-9-CM CODE

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  • 726.31 Medial epicondylitis

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ICD-10-CM CODE

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  • M77.00 Medial epicondylitis, unspecified elbow

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PREFERRED PRACTICE PATTERN

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation1

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PATIENT PRESENTATION

A 37-year-old male has come to the physical therapy out-patient clinic for an evaluation of his left upper extremity. As a part of his initial history, the patient states that he is a carpenter and enjoys recreational golf with friends on most weekends. The patient states that he has a high pain tolerance, but his current pain became more evident after a vigorous round of golf this weekend. He points to pain along the medial aspect of his left elbow. He has point tenderness with palpation of area with increased pain in elbow with wrist flexion and pronation of forearm. Imaging reveals calcification of medical collateral ligament of elbow. Rubor and warmth are present in the muscle bellies of flexor carpi ulnaris, pronator teres, palmaris longus, flexor digitorum superficialis, and flexor carpi radialis.

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KEY FEATURES

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Description
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  • Tendinosis of wrist flexor tendons that attach at medial humeral epicondyle2

  • Involvement of common flexor origin, flexor carpi radialis, and humeral head of the pronator teres

  • Normal collagen response is disrupted by fibroblastic, immature vascular response and incomplete reparative phase

  • Early stages may display inflammatory or synovitic characteristics

  • Later stages may demonstrate microtearing, tendon degeneration with or without calcification, or incomplete vascular response

  • Pain in medial elbow with resisted wrist flexion2

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FIGURE 165-1

A test for medial epicondylitis. Forced flexion of the wrist will cause pain over the medial epicondyle. (From Simon RR, Sherman SC. Emergency Orthopedics. 6th ed. www.accessemergencymedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Essentials of Diagnosis
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  • Caused by medial tension overload of the elbow associated with repetitive microtrauma of flexor–pronator musculature at its origin on medial epicondyle2

  • Usually affects middle-aged clients; aging process leads to decreased mucopolysaccharide chondroitin sulfate within tissues, making tendons less extensible

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General Considerations
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  • Tendinosis affecting the elbow is rarely acute unless by direct trauma (then characterized as tendonitis.)3

  • Pain is usually associated with activity, more so afterward.

  • Onset of pain is associated with wrist flexion.

  • Direct blows to the medial epicondyle can initiate symptoms.

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FIGURE 165-2

Stress test of the collateral ligaments of the elbow. (From Simon RR, Sherman SC. Emergency Orthopedics. 6th ed. www.accessemergencymedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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