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  • Medial tendon injury
  • Medial tendonitis
  • Golfer’s elbow
  • Bowler’s elbow
  • Little leaguer’s elbow

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  • 726.31 Medial epicondylitis

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  • M77.00 Medial epicondylitis, unspecified elbow

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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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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 forearm, wrist, hand motions

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Differential Diagnosis

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