Medial Epicondylitis

What is Medial Epicondylitis?

Medial Epicondylitis is an overuse injury often associated with excessive or repetitive stress to the muscles in the forearm that control elbow/wrist flexion and pronation.  It is a type of tendonitis that results in pain and tenderness along the inside of the elbow joint.  In some cases, it may radiate down the inside of the arm to the 4th and 5th digits (Ring and pinky fingers).  Medial epicondylitis affects the wrist flexors and pronators (Located on the front and inside of your forearm), which typically become irritated at their origin on the medial epicondyle of the humerus (Upper arm bone).  The specific muscles most commonly involved are the palmaris longus, flexor carpi radialis, and pronator teres.  The palmaris longus and flexor carpi radialis are both wrist flexors, meaning that they work concentrically (Shorten) to bring the palm toward the inside of the forearm and eccentrically (Lengthen) to control the opposite motion.  The pronator teres muscle pronates the forearm meaning that it turns the forearm/palm to face down.

This injury is common among athletes who play golf and/or baseball, but is not limited to these individuals and can often occur in those who participate in racket sports (Tennis), throwing sports (Football, archery), and weight training when the improper technique is used resulting in increased stress on the medial elbow joint.  Occupations that involve extensive typing (desk jobs), or forceful and repetitive movements (Carpentry) may also predispose individuals to medial epicondylitis.  Other factors that may put an individual at an increased risk for medial epicondylitis are >40 years old, obesity, and smoking regularly.  Medial epicondylitis occurs equally in males and females with the majority reporting their dominant upper extremity to be affected.

Medial Epicondylitis

How is Medial Epicondylitis Diagnosed?

Medial epicondylitis is diagnosed through clinical examination.  

Signs and symptoms include:

  • Subjective pain in medial elbow/arm with gripping or lifting activities
  • Sensation of elbow stiffness but typically full range of motion
  • Point tenderness with palpation along the medial epicondyle and into the muscle
  • Weakness and/or pain with resisted wrist and elbow flexion and/or pronation
  • Pain with passive wrist and elbow extension and/or supination
  • Decreased grip strength
  • Possible numbness/tingling in the 4th and 5th fingers

During the examination, it is also important to rule out medial elbow instability, ulnar nerve injury, and shoulder or neck pathology.

How can a Therapist Help with Medial Epicondylitis?

Treatment for medial epicondylitis is typically divided into three rehabilitative phases:

Phase I: Manage pain, Promote healing, and Protect function

  • Relative rest (Avoid aggravating activities, but continue other exercises)
  • Use of ice and NSAIDs
  • Gentle stretching to protect involved tendons without losing range of motion
  • Gentle soft tissue massage to surrounding tissues to promote circulation
  • Isometric strengthening
  • Short-term bracing (When indicated) to relieve stress at the attachment during gripping

Phase II: Strengthening, flexibility, and symptom control

  • Progressive concentric and eccentric strengthening of wrist flexors and pronators 
  • Scapular and shoulder strengthening and stabilization
  • Ice massage and manual therapy (Joint mobilization and cross friction massage)
  • Stretching of wrist extensors
  • Neural gliding
  • Proprioception 
  • Dry needling
  • Iontophoresis

Phase III: Return to activity

  • Analyze specific movements and postures related to activity
  • Consider increasing grip size; may use counterforce brace

Medial epicondylitis has a favorable prognosis and most individuals will return to work or sport following completion of their physical therapy treatment.  Corticosteroid injections may offer short term relief but physical therapy is more beneficial for intermediate and long term outcomes.  Surgery may be considered after 9-12 months of failed conservative management.