Elbow / Wrist / Hand

Medial Epicondylitis (golfer’s elbow)

Definition

Medial epicondylitis is inflammation in the insertion of the wrist flexors/pronators and is accompanied by pain in the medial elbow and lower arm. Mucoid degeneration develops with neovascularisation.

Aetiology

The pain in medial epicondylitis is due to overload of one of the flexors/pronators of the wrist flexors/pronators, causing mucoid degeneration with neovascularisation.

In general practice, the incidence is thought to be much lower (7 to10 times) than lateral epicondylitis.

Overload of the wrist flexors/pronators can be the consequence of co-existing shoulder, elbow or wrist restrictions. Moreover, sports such as baseball can play a role in causing medial epicondylitis.

Segmental dysfunction of the cervical spine and cervicothoracic junction can play a role in the clinical picture. Therefore, in addition to the evaluation of shoulder function, it is very important to examine the cervical spine as well.

Signs and symptoms

In general, the symptoms are characterised by pain in the elbow provoked by activities involving the wrist flexors/pronators.

Diagnostics

Physical Examination

Examination for medial epicondylitis mainly consists of muscle resistance tests in the wrist flexors/pronators. In addition, active and passive elbow flexion/extension and examination of the wrist and shoulder should be included.

Additional Somatic Diagnostics

  • In the first phase of uncomplicated medial epicondylitis, no imaging techniques or blood tests are indicated.
  • When the complaints persist: Imaging techniques (MRI scan, CT scan, ultrasound) are required.
  • RAND-36 (quality of life)
  • VAS Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

Other Treatments

Interventional Pain Treatment