Medial Epicondylalgia

• Medial Epicondylalgia:

  • less common than lateral epicondylalgia, medial epicondylalgia or "golfers elbow" accounts for 9 to 20% of all epicondylalgia cases
• Medial Epicondylalgia:

  • what
  • tendinopathic condition
  • overload of the wrist flexor and pronator muscles
  • where
  • pain over medial epicondyle or 1 - 2 cm distally
  • how
  • overuse injury (more common in the dominant arm)
  • can also be caused by sudden onset due to high exertion
  • who
  • increased risk if:
  • current/ex smoker
  • type 2 diabetes
  • more related to manual work than a sports injury
  • but if it does occur in sporting population, its more common in throwing or racket sports than golf
• Medial Epicondylalgia - Subjective Features:

  • pain on palpation and/or wrist flexion activities
  • often worse with combined wrist and finger flexion + pronation
  • pain over the medial epicondyle
  • can radiate into ulnar side of the forearm
  • pain aggravated by overuse and eased by rest
  • often pain with gripping and pulling
• Medial Epicondylalgia - Objective Features:

  • observations
  • nothing obvious upon observation
  • ROM
  • full ROM at the elbow, wrist and hand
  • palpation
  • tenderness over medial epicondyle +/- 1 to 2 cm distally
  • tenderness over pronator teres and flexor carpi radialis
  • resisted testing
  • pain on resisted wrist flexion, pronation and gripping
  • often worse with combined movement
• Medial Epicondylalgia - Special Tests:

  • Reverse Mills Test
• Medial Epicondylalgia - Physiotherapy Management:

  • same principles as lateral epicondylalgia with a focus on flexors and pronators
  • advice and education
  • tendinopathy pathophysiology
  • load management
  • cease/limit aggravating activities
  • ergonomics
  • tools/technique
  • self-management/symptom control
  • symptom control
  • load management/activity modification
  • taping/bracing
• Medial Epicondylalgia - Physiotherapy Management:

  • build capacity
  • gradual loading
  • isometric contractions
  • eccentric/concentric training
  • progressive resistance training of the upper limbs and wrist extensors (pain free)
  • +/- stretching
  • return to function
  • graded return to activity
  • sport/work/function specific loading
  • review technique
  • review training/work patterns