Medial epicondylitis is pain over the bone on the inner side of the elbow. The piece of bone that can be felt on the inner side of the elbow is called the medial epicondyle. When the tendons attached to this bone are overstretched or torn, they become inflamed and painful.

Medial epicondylitis is commonly called golfer's elbow, but it is not restricted to people who play golf. It can occur in tennis players and other people who repeatedly grip objects tightly.

Causes

Golfer's elbow is caused by overusing the flexor muscles of the forearms. Overusing these muscles can stretch or tear the tendons attached to the medial epicondyle.

Causes include:

• Improper golf swing technique or grip of golf clubs

• Wrong model of golf clubs

• Improper technique for hitting a tennis ball

• Improper size of tennis racquet or tension of racquet strings

• Doing certain arm motions too much, such as:

• • Golf swings

• • Tennis strokes (forehand or serve)

• • Painting

• • Raking

• • Pitching

• • Rowing

• • Using a hammer or screwdriver

Risk Factors

A risk factor is something that increases your chance of getting a disease, condition or injury. Risk factors for medial epicondylitis include:

• Playing golf or tennis

• Work that requires repetitive gripping or clenching of the fingers

• Muscle imbalance

• Decreased flexibility

• Advancing age

Symptoms

Symptoms include:

• Pain or tenderness on the inner side of the elbow

• Pain increases when:

• • Shaking hands

• • Turning doorknobs

• • Picking up objects with your palm down

• • Hitting a forehand in tennis

• • Swinging a golf club

• • Applying pressure to this area

• Possibly pain extending down the forearm

• Tightness of forearm muscles

• Stiffness or trouble moving the elbow or hand

Diagnosis

The doctor will ask about your symptoms and medical history, your recent physical activity, and how the injury occurred. You may not remember the event that caused the injury because golfer's elbow pain develops over time. The doctor will examine your elbow for:

• Pain on the inner side of the elbow when:

• • Doing certain arm motions

• • Pressing on the medial epicondyle

• Stiffness of elbow and pain with wrist movement

X-rays are not usually necessary, but the doctor may decide to x-ray your elbow to:

• Make sure the bones of the elbow are normal

• Look for a calcium deposit in the injured tendons

Magnetic resonance imagery (MRI) is occasionally used for diagnosis, but there is only limited evidence supporting this use.

Treatment

Treatment includes:

Rest - Do not do activities that cause pain. Do not play sports, especially golf and tennis, until the pain is gone.

Cold – Apply ice or a cold pack to the inner side of the elbow for 15-20 minutes, 4 times a day for several days after the injury. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.

Medication – Take one of the following drugs to help reduce inflammation and pain:

• Ibuprofen (Motrin, Advil)

• Naproxen (Aleve, Naprosyn)

• Acetaminophen (Tylenol)

• Aspirin

If you still have tenderness in the elbow while taking these drugs, do not return to physical activity. Check with your doctor.

Compression – Wear a counter-force brace on your forearm if recommended by your health care professional. This brace limits the force generated by your forearm muscles when you use them.

Heat – Apply heat to the elbow only when you are returning to physical activity. Then use it before stretching or getting ready to play sports.

Stretching – When the acute pain is gone, start gentle stretching as recommended by a health care professional. Stay within pain limits. Hold each stretch for about 10 seconds and repeat 6 times.

Strengthening – Begin strengthening exercises for the flexor muscles of the forearm as recommended by a health care professional.

Gradual Return to Your Sport – Begin arm motions of your sport or activity as recommended by a health care professional. (For example: golf swings, tennis strokes, painting)

Cortisone Injection – The doctor may inject cortisone into the elbow near the medial epicondyle to reduce pain and inflammation.

Prevention

Take these steps to reduce your risk of getting golfer's elbow:

• Keep your arm muscles strong so they can absorb the energy of sudden physical stress.

• After a short warm-up period, stretch out your arm muscles before physical activity.

• Learn the proper technique for activities that require forearm motion.

• If you play golf, ask a golf specialist to check your:

• • Swing technique

• • Grip

• • Model of golf clubs

• If you play tennis, ask a tennis specialist to check your:

• • Technique for hitting a forehand

• • Racket size and tension of racket strings

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org

American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

References:

American Academy of Orthopaedic Surgeons

American Orthopaedic Society for Sports Medicine

Assessment and treatment guidelines for elbow injuries.The Physician and Sportsmedicine. 1996;24:42.

Human Tendons. Human Kinetics; 1997.

Managing golf injuries. The Physician and Sportsmedicine. 1999;29:41.

Nicholas Institute of Sports Medicine and Athletic Trauma