Epicondylitis, medial

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

• 726.31 Medial epicondylitis

• M77.00 Medial epicondylitis, unspecified elbow

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

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• 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

Demographics3

• 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

Signs and Symptoms

• 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

Functional Limitations

• Pain with pinching, squeezing, holding heavy objects, wringing
• Pain with movements of the hand and wrist
• Loss of strength
• Difficulty with grasping activities

Possible Contributing Causes

• 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

Differential Diagnosis

• Medial ulnar collateral ligamentous instability
• Ulnar neuritis
• Compression or entrapment of ulnar nerve
• Rheumatoid arthritis
• Medial ...