Medial epicondylopathy

Definition

• Also called Golfer’s elbow, common flexor tendon lesion, medial epicondylitis
• Microtrauma and degeneration of the tendons attached via the common flexor tendon at the medial epicondyle of the elbow
• The common flexor tendon consists of the following 5 muscles
  • Pronator teres
  • Flexor carpi radialis
  • Palmaris longus
  • Flexor digitorum superficialis
  • Flexor carpi ulnaris
• The common flexor tendon is about 2,5-3cm in length
• The common flexor tendons provides dynamic stability to the elbow¹,²,³

 

Occurrence

• Typically occurs in patients between 40-60 years of age
• Medial epicondylitis occurs more rarely than lateral, and account for 10-20% of the cases

 

Causes

• Usually results from overuse after repetitive eccentric loading of the muscles responsible for wrist flexion and forearm pronation, or valgus stress which leads to microtrauma and subsequent degeneration of these tendons⁴
• Office work
• May occur as a result of traumatic event
  • As a result from a sudden violent contraction of the muscles⁵
• Overhead athletic activity such as golf, javelin throwing, baseball, tennis⁶,⁷,⁸,⁹
• Manual labor especially with forceful work¹⁰

 

Localization

• At the medial epicondyle where the common flexor tendon of the following muscles attach
  • Pronator teres
  • Flexor carpi radialis
  • Palmaris longus
  • Flexor digitorum superficialis
  • Flexor carpi ulnaris
• Two sites are common
  • At the tenoperiost, the anterior aspect of the medial epicondyle
  • At the musculotendinous junction, at the level of the inferior edge of the epicondyle

 

Risk factors

• Patients who have suffered any of the following ailments prior may be especially at risk for developing medial epicondylitis ¹¹
  • Shoulder tendinopathy
  • Carpal tunnel syndrome
  • Lateral epicondylitis
  • Ulnar nerve entrapment
• Lack of strength, endurance or flexibility¹²
• Smoking
• Type 2 diabetes

 

Indications

• Pain felt at the medial epicondyle radiating down the proximal medial forearm
• Pain or weakness in forceful grip
• Stiffness of elbow
• Numbness or tingling (up to 20% report ulnar nerve symptoms)

 

Examination

• Pain and/or weakness during resisted flexion of the wrist with elbow held in extension
• Pain and/or weakness during resisted pronation
• Palpation – tenderness at medial epicondyle
• Swelling, redness and warmth may be present during acute stages

 

Patient recommendation

• Decreasing volume, frequency, or intensity of provocative activity