Practice Essentials

Medial epicondylitis, or "golfer's elbow," is similar to the more common lateral epicondylitis ("tennis elbow") in many respects. Both conditions are overuse tendinopathies that can be associated with racquet sports. Other activities with which medial epicondylitis are associated include golfing and throwing sports. Medial epicondylitis has also been reported in bowlers, archers, and weight lifters.^{[1, 2, 3, 4]}

Little Leaguer's elbow is sometimes considered a variant of medial epicondylitis, but this condition is technically a traction apophysitis of the medial epicondyle, which requires a different treatment course.

Educate athletes about the importance of forearm strengthening and stretching, appropriate training volume and intensity, proper technique, and equipment selection to decrease the risk of future injury.

Etiology

Causes of medial epicondylitis include the following:

Training errors: These errors may increase the risk of developing medial epicondylitis. Athletes usually have a history of increased intensity or duration of activity, and they may not warm up adequately.
Improper technique: This is one of the major causes of medial epicondylitis. Tennis players with excessive top spin, poor serves and forehand strokes are at greater risk of developing medial epicondylitis.^[1]
Equipment: The use of an incorrectly sized tennis racquet grip, overly tightened racquet strings, older tennis balls, and wet tennis balls may increase elbow stress. The use of graphite racquets and larger headed racquets can decrease elbow stress.^{[1, 2]}
Functional risk factors: Weakness, poor endurance, and poor flexibility of the forearm may increase the risk of developing medial epicondylitis.

United States statistics

Medial epicondylitis accounts for only 10-20% of all epicondylitis diagnoses^[1]; the annual incidence is between 3-4 per 10,000 patients in the United States and is more common in patients aged 40 years and older.^[5] The condition is classically described in the dominant elbow of a golfer.^[6]Tennis players who hit their forehand with a heavy topspin are also at increased risk for developing medial epicondylitis.

Functional Anatomy

The medial epicondyle is the common origin of the forearm flexor and pronator muscles. The most common site of pathology is the interface between the pronator teres and the flexor carpi radialis origins.^{[7, 8]}The flexor pronator muscle group serves as a secondary stabilizer of the medial elbow, assisting the ulnar collateral ligament (UCL).

See the image below.

Medial epicondyle.

Sport-Specific Biomechanics

Immunohistologic studies have shown that long-standing epicondylitis is associated with a degenerative state instead of a traditional inflammatory process and probably should more accurately be called "epicondylosis."^{[9, 10]}Valgus stresses are placed on the elbow by activities such as throwing and golfing; valgus stress on the medial elbow is especially high during the late cocking and acceleration phases of a throw and during a golf swing (from the top of the backswing to just before ball impact).^[11]

Prognosis

The duration of the patient's symptoms is related to the length of time before the athlete receives treatment. Those athletes who delay treatment tend to have a slower recovery course.^[1]

Complications

Rarely, chronic medial epicondylitis may be related to an increased risk of muscle rupture.^[1]

Clinical Presentation

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