Dr Harith Rosdi
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Medial Epicondylitis (Golfer’s Elbow)

Tendinopathy of the common flexor-pronator origin at the medial epicondyle, mainly <strong>pronator teres and flexor carpi radialis</strong>. Degenerative, not inflammatory. About 5 to 10 times less common than lateral epicondylitis, and often more refractory.

Mechanism and risk

  • Repetitive wrist flexion and pronation, especially with valgus stress (the classic throwing mechanism)
  • Repetitive gripping with a flexed wrist, or a single forceful flexion-pronation
  • Sports: golf (trailing arm), baseball and softball pitching, javelin, tennis (forehand, serve), cricket bowling, rowing, weightlifting, climbing
  • Modifiable: poor throwing or racquet technique, load spikes, weak forearm, occupational gripping
  • Non-modifiable: age 35 to 60, male sex, smoking, diabetes

Presentation

  • Medial elbow pain radiating into the forearm flexors
  • Worse with gripping, wrist flexion, pronation and throwing
  • Focal tenderness just distal to the medial epicondyle
  • Pain on resisted wrist flexion and resisted pronation

Always assess the ulnar nerve and ligament

  • Ulnar neuropathy coexists in up to 20 to 60%. Ask about tingling in the ring and little fingers and test for Tinel’s sign at the cubital tunnel. Missing it means treating the wrong problem.
  • Ulnar collateral ligament (UCL) injury in throwers must be excluded with a valgus stress test. It changes management entirely.

Management

Mirrors lateral epicondylitis.

  1. Load management or relative rest: first-line.
  2. Progressive exercise: flexor-pronator strengthening (eccentric and concentric) and stretching are the cornerstone.
  3. Counterforce brace and NSAIDs: short-term, symptomatic.
  4. Corticosteroid injection: short-term relief only, with the same worse medium-term outcomes as lateral epicondylitis. Avoid in throwers (rupture risk) and take care near the ulnar nerve.
  5. Shockwave, PRP: modest benefit in chronic cases.
  6. Surgery: flexor-pronator debridement, with ulnar nerve decompression or transposition if neuropathy coexists. Reserved for cases failing 6 to 12 months of conservative care.

Prognosis

More refractory than the lateral form, with recovery often taking 6 to 12 months.

References

  1. Medial epicondylitis: evaluation and management, J Am Acad Orthop Surg 2015, doi:10.5435/jaaos-d-14-00145
  2. Clin Sports Med 2004, doi:10.1016/j.csm.2004.04.011

Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.