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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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Key Features

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Description

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  • Tendinosis of wrist flexor tendons that attach at medial humeral epicondyle

  • Involvement of common flexor origin, flexor carpi radialis, 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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Essentials of Diagnosis

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  • Caused by medial tension overload of the elbow associated with repetitive micro-trauma of flexor-pronator musculature at its origin on medial epicondyle

  • 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 direct trauma (then characterized as tendonitis)

  • Pain usually associated with activity, more so afterward

  • Onset of pain associated with wrist flexion

  • Direct blows to medial epicondyle can initiate symptoms

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Demographics3

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  • People aged 12 to 80 years

  • More common during fourth and fifth decade of life

  • Males and females equally affected

  • 75% of patients are symptomatic in their dominant arm

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Clinical Findings

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Signs and Symptoms

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  • Pain of insidious onset

  • Pain and tenderness over medial epicondyle

  • Pain may be related to wrist flexion and pronation

  • Pain response varies between dull ache, no pain at rest, sharp pain with activities

  • Active movement may reproduce pain

  • Passive movement of full wrist extension with supination and elbow extension reproduces pain at medial epicondyle

  • Resistive isometric: resisted wrist flexion and resisted wrist pronation reproduces pain at medical epicondyle

  • Elbow-joint movements should be full and painless

  • Palpation tenderness at medial epicondyle within the musculature of flexor carpi ulnaris, pronator teres, palmaris longus, flexor digitorum superficialis, and flexor carpi radialis

  • Rubor and warmth may be present over medial epicondyle or proximal 5-10 mm of associated muscle belly

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Functional Limitations

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  • Pain with pinching, squeezing, holding heavy objects, wringing

  • Pain with movements of the hand and wrist

  • Loss of strength

  • Difficulty with grasping activities

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Possible Contributing Causes

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  • Occupations requiring repetitive use of hands for excessive periods of time

  • Direct trauma to tendon or wrist

  • Sports or occupational activities

    • Tennis, golf, bowling, football, archery, weightlifting

    • Carpentry, plumbing, mechanic

  • Most commonly results from repetitive ...

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