What is it?

Medial epicondylitis occurs with pain and inflammation on the inside of the elbow where the muscles that flex the wrist attach to the bone. This can occur not only in golfers, but also those who perform repeated motions of the wrist.

What are the symptoms?

People with medial epicondylitis experience pain and tenderness on the inside or medial side of the elbow, pain or weakness when gripping or twisting the wrist, and pain when lifting objects.

What causes this?

Epicondylitis is caused by repetitive stress and strain to the muscles and tendons that attach the forearm muscles to the elbow, including any sudden change in activity level or intensity, or an incorrect grip or grip size in racquet sports. This repetitive stress causes microscopic tearing of the tendon. Because the blood supply to this area is poor, the healing response is limited.


Figure 1: From Jobe FW: Operative
Techniques in Upper Extremity Sports Injuries.
St. Louis, Mosby Year Book, 1996, p.441.


What is the treatment?

Step 1: Initially, treatment consists of anti-inflammatory medications and a stretching and strengthening program. Stretching is a key component in treating epicondylitis. Each stretch should be held for at least 10 seconds, then relax the arm and repeat up to several times a day and in between activities. Minimally 3 sets of 20 repetitions should be performed. (See Figure 2.)

Strengthening exercises will also help. (Figures 3-8.) You should never experience pain when performing strengthening exercises. Use a light weight and perform at least three sets of 20 repetitions.


Figure 2: Stretching


Step 2: If symptoms continue after a trial of stretching and strengthening, you may benefit from a cortisone injection. Cortisone decreases inflammation and increases blood flow to the area aiding healing. Most patients feel relief after one injection, but up to three cortisone injections over a period of time may be given.

Step 3: If stretching and strengthening, antiinflammatory medications and cortisone injections do not relieve symptoms, then surgery is an option. Through a small incision over the bony prominence on the inside of the elbow, the base of the diseased tendon is removed and normal tendon tissue is reattached to the bone. This is an outpatient surgery.

Figure 3: Wrist Extensors	Figure 4: Wrist Flexors
Figure 5: Radial Deviation	Figure 6: Ulnar Deviation
Figure 7: Supination	Figure 8: Pronation

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