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Medial epicondylitis
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Medial epicondylitis

Contributors: Brianna Caraet MD, Sandeep Mannava MD, PhD
Other Resources UpToDate PubMed

Synopsis

Medial epicondylitis, also known as golfer's elbow, is the most common cause of medial elbow pain. It occurs in less than 1% of the general population and affects the dominant arm in 75% of patients. It is less common than lateral epicondylitis (tennis elbow) and comprises only 10%-20% of epicondylitis cases.

The common flexor tendon (CFT) attaches to the medial epicondyle of the humerus and the anterior bundle of the ulnar collateral ligament (UCL). The CFT is comprised of the tendons of the following 5 muscles:
  • Flexor carpi radialis (FCR)
  • Flexor carpi ulnaris (FCU)
  • Flexor digitorum superficialis (FDS)
  • Pronator teres (PT)
  • Palmaris longus
With the exception of the palmaris longus, all of the other common flexor muscles are involved in this pathology.

Causes / typical injury mechanism: Medial epicondylitis presents as insidious or acute medial elbow pain that is worsened by repetitive wrist flexion, forearm pronation, and valgus overload on the elbow.

Classic history and presentation: This mechanism is most commonly work related and can be seen in manual labor occupations such as construction, plumbing, and carpentry. It is also observed in athletes who participate in baseball, golf, tennis, football, weightlifting, and bowling. In throwers, medial epicondylitis is exacerbated during the late cocking or early acceleration phase. This condition classically presents after repetitive use with medial pain at the elbow.

Prevalence:
  • Age – Often seen in the 4th through 6th decades of life.
  • Sex / gender – Equally affects men and women.
Risk factors: In addition to repetitive movements and forceful activities, medial epicondylitis has also been associated with smoking and obesity.

Pathophysiology: Degeneration begins at the common flexor origin when this repetitive trauma causes peritendinous inflammation. Histologically, angiofibroblastic hyperplasia is observed as vascular and fibroblastic elements invade the tendon. Ultimately, this results in hyaline degeneration and irreparable fibrosis / calcification of the flexor-pronator musculotendinous mass.

Codes

ICD10CM:
M77.00 – Medial epicondylitis, unspecified elbow

SNOMEDCT:
53286005 – Medial epicondylitis of elbow joint

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • C6 and C7 cervical radiculopathy – Forearm muscle imbalance predisposes to medial epicondylitis.
  • Triceps tendonitis
  • Snapping medial head of triceps – Pain is more posteriorly located.
  • Ligamentous instability
  • Elbow arthritis
  • Intraarticular elbow fracture
  • Muscle strain
  • Herpes zoster

    Best Tests

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    Therapy

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    Last Reviewed:09/11/2020
    Last Updated:12/16/2020
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    Medial epicondylitis
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