Medial Epicondylitis (Golfer's elbow)

Medial epicondylitis, also known as golfer's elbow is far less common than lateral epicondylitis (tennis elbow) but is the most common cause of medial sided elbow pain.  Similar to tennis elbow, medial epicondylitis is frequently caused by repetitive activity encountered at work or during sporting activities.  It presents as pain over the inside aspect of the elbow and is worsened by lifting carrying and gripping activities.  The area can be extremely tender to the touch and pain may radiate down the forearm. Sometimes an associated irritation of the ulnar nerve may occur, causing numbness and tingling into the ring and small fingers.


DIAGNOSIS

Patients with golfer's elbow typically have pain and tenderness on the inner aspect of the elbow.  Lifting, carrying, and even hand shaking causes a sharp pain that may radiate down from the elbow to the wrist.  Throwing athletes may have pain during the throwing motion and prolonged soreness after activity.

Examination findings include tenderness directly over the medial epicondyle and pain with resisted wrist flexion or forearm pronation.  Some patients will demonstrate signs of ulnar nerve compression at the elbow with sensitivity over the ulnar nerve or numbness and tingling in the ring and small fingers known as cubital tunnel syndrome. 


IMAGING

The diagnosis of golfer's elbow can usually be made solely on examination, but imaging of the elbow may be helpful in particular cases.  MRI or Ultrasound can be used to diagnose medial epicondylitis and assess the severity of the disease.  If ulnar nerve symptoms are present, EMG or nerve conduction tests may be performed to evaluate for cubital tunnel syndrome.


NON-OPERATIVE TREATMENT

In the majority of cases, medial epicondylitis will resolve with non-surgical treatments alone.  There are a variety of treatments that have been used to treat the disorder, which include:

Medication

Over the counter Non-Steroidal Anti-Inflammatories (NSAIDs) and prescription topical anti-inflammatory creams are often part of the first line of treatment.  While the pathology of medial epicondylitis relates more to scar than inflammation, these medications often have positive responses with patients.

Stretching & Strengthening

Stretching and strengthening exercises can be done at home or with the help of a physical therapist.  These are specific exercises focused on gentle stretching and progressive strengthening of the injured tendons attaching to the medial epicondyle. 

Bracing

Braces are typically used to unload the areas of stress.  A counterforce brace is placed several finger-breadths below the medial epicondyle around the forearm and acts to off-load the stresses placed on the elbow. Wrist control splints can also be used. They help limit excessive wrist motion, therefore reducing the pulling stress at the attachment site of these tendons at the elbow.

Corticosteroid or PRP injections

When other options fail to provide relief, an injection of corticosteroid may be considered.  Platelet-rich plasma (PRP) injections have been shown to have some success as well for treating medial epicondylitis.  Injections at the site of pain can significantly reduce symptoms for up to 3 months, but may not be curative for the disorder when used alone without other treatments like bracing and exercises. 


OPERATIVE TREATMENT

When non-operative treatment fails, surgical treatment can be considered.  There are three methods of surgical treatment for golfer's elbow:

    - Open Surgery

    - Arthroscopic Surgery

    - Percutaneous Tendon Release

If surgery is indicated, your surgeon will discuss with you the advantages and disadvantages of each technique depending on your specific symptoms as well as your individual demands, occupation, and recreational activities.




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