Hand Surgery Source

Medial Epicondylitis Tenderness

Test, Exam and Signs

Historical Overview

  • Medial epicondylitis is also described as “golfer’s elbow.”

Description

  • Patients usually experience medial epicondyle tenderness and/or pain anterior and distal to the anterior midpoint of the medial epicondyle of the pronator teres (PT) and flexor carpi radialis (FCR).1
  • With medial epicondylitis, resisted pronation of the forearm with the wrist in flexion often causes pain.

Pathophysiology

  • During activities of wrist flexion and forearm pronation, flexor-pronator degeneration occurs with forced wrist extension and forearm supination.2
  • Medial epicondylitis is the result of an angiofibroblastic response, not of an inflammatory process. This response may result from microtrauma of the FCR and PT tendons, with an incomplete reparative response.1
  • In rare cases, medial epicondyle tenderness may be caused by a medial ulnar collateral ligament injury. When this ligament is disturbed, unusual stress is placed on the articular surfaces, which may change osteophyte formation.3

Instructions

  1. Record the patient’s history, including any sports-related injuries.
  2. Ask the patient to rate on a scale from 1 to 10 the amount of pain s/he usually experiences at the medial epicondyle.
  3. Apply pressure to the medial epicondyle, approximately 5-10 mm anterior and distal to the anterior midpoint of the medial epicondyle of the PT and FCR.1
  4. Check for tenderness and pain.
  5. Examine the medial epicondyle on the contralateral side for comparison.

Related Signs and Tests

  • Medial epicondylitis tenderness with resisted wrist flexion
  • Lateral epicondyle tenderness
  • Ulnar nerve conduction studies
  • Radiographs
  • MRI and ultrasound

Diagnostic Performance Characteristics

  • To improve reliability, palpate the medial epicondyle from various directions.
  • Do not use other patients’ reactions as a comparison, because other patients may have different perceptions of similar tenderness and/or pain.
Presentation Photos and Related Diagrams
  • Palpating medial epicondyle for point tenderness
    Palpating medial epicondyle for point tenderness
Definition of Positive Result
  • A positive result occurs when there is increased tenderness with pressure.
Definition of Negative Result
  • A negative result occurs when pressure does not cause increased tenderness. 
Comments and Pearls
  • Always compare the symptomatic elbow to the opposite asymptomatic elbow when assessing medial epicondylar tenderness.
  • Treatment for medial epicondylitis may include corticosteroid injections. If this approach is unsuccessful, an exercise regimen may help to improve strength and flexibility.1
  • Once severe symptoms are alleviated, concentrate on flexor-pronator mass rehabilitation and injury prevention.2
Diagnoses Associated with Tests, Exams and Signs
References
  1. Culp R, Jacoby S.  Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  2. Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg 2015;23(6):348-55. PMID: 26001427
  3. Field LD, Savoie FH. Common elbow injuries in sport. Sports Med 1998;26(3):193-205. PMID: 9802175
  4. Taylor SA, Hannafin JA. Evaluation and Management of Elbow Tendinopathy. Sports Health 2012;4(5):384-93. PMID: 23016111