Golfers elbow or medial epicondylitis is overuse tendinopathy that can be associated with golfing, racquet sports [most likely due to valgus stresses placed at medial epicondyle], throwing sports, bowlers, archers, and weightlifters.
Just as lateral epicondyle is the site for the origin of wrist and hand extensors, medial epicondyle is the site for wrist and hand flexors and pronator muscle. Pronator teres and the flexor carpi radialis are most common muscles involved in medial epicondyltis.
Training errors, lack of proper technique and equipment, weakness, poor endurance, and poor flexibility of the forearm may increase the risk of developing medial epicondylitis.
Clinical Presentation of Medial Epicondylitis
The main complaint is the pain over the medial or inner side of the elbow. Grip weakness may be reported. The pain increases with the activity of elbow. On examination, there is tenderness over medial epicondyle and pain on resisted flexion and pronation.
Ulnar collateral ligament should be assessed as ulnar collateral ligament deficiency can present in a similar manner. MRI can differentiate between the two.
Cervical Radiculopathy, Elbow and Forearm Overuse Injuries, Little League Elbow Syndrome and Ulnar Collateral Ligament Injury should be ruled out.
These are generally not required.
Imaging in Medial Epicondylitis
Imaging is generally not required for diagnosis. It is done in cases where there is a history of trauma or cases refractory to treatment or when medial epicondyle apophysitis is suspected in a pediatric case.
Bone scanning helps to identify stress fractures, infection, and tumors. CT is useful to rule out osteochondritis dissecans and stress fractures. MRI is better at identifying osteochondritis dissecans and ligament injury.
Treatment of Medial Epicondylitis
NSAIDs, rest, ice, compression, and elevation (RICE) is the mainstay in the acute phase. Frequency, intensity and amount of activity should be restrained. Counterforce bracing and cock-up wrist and elbow taping have been found useful.
If conservative treatment fails (usually 6-12 months), surgical release of the flexor origin and excision of the pathologic tissue should be done. In general, good results are reported in greater than 80% of patients.
Corticosteroids steroid injections, autologous blood injection or platelet-rich plasma injection improve the symptoms in short term. Alternative treatments are either.
Forearm stretching, wrist flexors pronators strengthening exercises are added after acute phase has ended. Patients who do not improve after 6 months of surgery can be considered for surgical release of flexor pronator origin.