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Medial epicondylitis is inflammation of the flexor pronator muscle mass originating at the medial epicondyle of the elbow. Diagnosis is with provocative testing. Treatment is rest and ice and then exercises and gradual return to activity.

Medial epicondylitis is caused by any activity that places a valgus force on the elbow or that involves forcefully flexing the volar forearm muscles, as occurs during pitching, golfing with improper technique, serving a tennis ball (particularly with top spin, with a racket that is too heavy or too tightly strung or has an undersized grip, or with heavy balls), and throwing a javelin. Nonathletic activities that may cause medial epicondylitis include bricklaying, hammering, and typing.

Symptoms and Signs

The patient reports pain in the flexor pronator tendons (attached to the medial epicondyle) and in the medial epicondyle when the wrist is flexed or pronated against resistance.

Diagnosis

• Provocative testing

To confirm the diagnosis, the examiner has the patient sit in a chair with the forearm resting on a table and the hand supinated. The patient tries to raise the fist by bending the wrist while the examiner holds it down. Pain around the medial epicondyle and in the flexor tendon origin confirms the diagnosis.

Treatment

• Rest, ice, and muscle stretches
• Modification of activity
• Later, resistive exercises

Treatment is symptomatic and similar to that of lateral epicondylitis (see Exercise and Sports Injury: Treatment). Patients should avoid any activity that causes pain. Initially, rest, ice, NSAIDs, and stretching are used, occasionally with a corticosteroid injection into the painful area around the tendon. When pain subsides, gentle resistive exercises of the extensor and flexor muscles of the forearm are done, followed by eccentric and concentric resistive exercises. In general, surgery is considered only after at least 9 to 12 mo of failed conservative management. Surgical techniques to treat medial epicondylitis involve removing scar tissue and reattaching damaged tissues.

Last full review/revision April 2009 by Brian D. Johnston; Paul L. Liebert, MD

Content last modified April 2009