II. Pathophysiology

  1. Flexor forearm Tendinopathy
    1. Flexor carpi radialis
    2. Pronator teres
  2. Repetitive motion injury in sports and manual labor
    1. Repetitive flexion with valgus stress at the elbow
    2. repetitive wrist flexion and pronation

III. Epidemiology

  1. Much less common than Lateral Epicondylitis

IV. Symptoms

  1. Dull ache at medial epicondyle
  2. Gradual onset of pain
  3. Pain radiates into Forearm
  4. Grip strength weakness

V. Signs

  1. Maximum tenderness localized within 1 cm distal and anterior to the medial epicondyle
  2. Provocative maneuvers eliciting pain
    1. Wrist flexion against resistance
    2. Forearm pronation against resistance (best Test Sensitivity for Medial Epicondylitis)

VI. Management: Initial

  1. See RICE-M
  2. Relative rest of Forearm pronators and wrist flexors
    1. Avoid repetitive motion activities
  3. Counterforce bracing
    1. Pad positioned over the proximal and medial Forearm (over the flexor-pronator complex)
    2. Variable evidence (see Lateral Epicondylitis)
  4. Wrist splint
    1. Indicated for severe medial epicondyliytis symptoms
  5. Elbow extension splint
    1. Indicated for comorbid Ulnar Neuropathy
    2. Splint at 30-45 degrees elbow flexion
    3. Worn only overnight

VII. Management: Rehabilitation

  1. Start after 1-6 weeks of initial therapy, and when free of pain on wrist flexion and Forearm pronation
  2. Step 1
    1. Start with gentle flexor and pronator stretches
  3. Step 2
    1. Advance to Isometric Exercises and then to Eccentric Exercises

VIII. Resources

  1. EMedicine Physical Medicine and Rehabilitation for Epicondylitis
    1. http://emedicine.medscape.com/article/327860-overview#showall

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Ontology: Medial epicondylitis (C0158309)

Concepts Acquired Abnormality (T020)
ICD9 726.31
ICD10 M77.0 , M77.00
SnomedCT 53286005, 156659008, 268088003, 24133009
Dutch golfer's elbow, mediale epicondylitis, epicondylitis; medialis, medialis; epicondylitis, Epicondylitis medialis
French Coude du golfeur, Epicondylite interne
German Golfellbogen, mediale Epikondylitis, Epicondylitis ulnaris humeri
Italian Gomito del golfista, Epitrocleite
Portuguese Cotovelo de jogador de golfe, Epicondilite interna
Spanish Codo del golfista, Epicondilitis medial, codo de golfista, epicondilitis interna, epitrocleítis (trastorno), epitrocleítis, inflamación de la epitróclea
Japanese ゴルフ肘, 内側上顆炎, ゴルフチュウ, ナイソクジョウカエン, ゴルフヒジ
English Medial epicondylitis of elbow joint, medial epicondylitis (diagnosis), medial epicondylitis, Medial epicondylitis, unspecified elbow, elbow epicondylitis medial, golfer elbow, elbow golfers, epicondylitis medial, Medial epicondylitis, Golfer's elbow, Medial epicondylitis of elbow, Medial epicondylitis of elbow joint (disorder), epicondylitis; medial, golfer's elbow, medial; epicondylitis, Golfers' elbow
Czech Golfový loket, Mediální epikondylitida
Korean 내측 상과염
Hungarian Epicondylitis medialis, Teniszkönyök