What is Medial Epicondylitis?
Medial epicondylitis is a pain and inflammation on the inside of the elbow. A person complains of pain from the elbow down to the wrist on the inside (medial) of the elbow. Repetitive forceful movements of the wrist usually cause the medial epicondylitis. These movements lead to micro-tears or inflammation of the tendons of the forearm muscles resulting in pain at the medial epicondyle.
Etiology of medial epicondylitis:
As mentioned above, the repetitive use of forearm muscles in a forceful way causes medial epicondylitis. In other words, a person places high tension on the tendons of the forearm muscles. This overuse of the muscles with higher force can damage the tendons.
It usually happens in sports like golf, while pitching a baseball. That is why medial epicondylitis is also known as Golfer’s elbow, baseball elbow, suitcase elbow, or forehand tennis elbow.
Below are the other possible causes of medial epicondylitis:
- Weakness in shoulder or wrist muscles
- Using inappropriate tennis or golf equipment
- Chopping wood with an ax repeatedly
- Operating a chainsaw
- Javelin throw
- Spin serve in tennis
- Overuse of hand tools in a repetitive manner
Anatomy of medial epicondyle :
The wrist flexors and pronators (mainly pronator teres) attach to the bony prominence on the inner side of the elbow (called medial epicondyle) as tendons. They are mainly responsible for wrist flexion, and pronation and therefore responsible for grip. Repetitive use of these muscles will cause microtears and inflammation to the tendons resulting in symptoms described above.
It is important to note that not all the functional gripping is affected with inflammation of these muscles. The majority of the functional grips require elbow in a midway (between pronation and supination). So a person with medial epicondylitis will complain of slight pain or discomfort while gripping but will still be able to perform the movement.
Signs and symptoms of medial epicondylitis:
A classic symptom of medial epicondylitis is pain along the inner side of the forearm, from the elbow extended to wrist to the little finger.
Wrist flexion (bending wrist towards the palm) against resistance is usually an aggravating factor for the pain. Additionally, the patient will also complain of pain while squeezing a ball.
Medical management of medial epicondylitis includes symptoms reduction and preventative measures.
The symptoms are managed with rest, ice and medication. Over the counter medications are usually enough to manage pain and inflammation.
Elbow braces can help to support the elbow and reduce the brace. One can use the brace even after the symptoms subside. Initially, braces will give some extra support that will prevent any recurrence of the injury.
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Since medial epicondylitis occurs due to repetitive forces, many people become symptomatic repeatedly. That is why it is important to find out the exact cause and work on it.
Proper ergonomics during golfing as well as tennis needs to be considered to avoid future incidents of the inflammation. Also, a person needs to have the appropriate equipment that matches their body anatomy. A sports coach or a sports physical therapist can guide specific to one should consider.
Physical therapy treatment:
Physical therapy after medial epicondylitis is crucial. A clinician can work on pain management, as well as the strengthening of the muscles around the wrist and fingers. In addition to the faster recovery, muscle strengthening, and stretching exercises also reduce the recurrences of the injury.
Below are a few exercises that PT will recommend after medial epicondylitis.
Once you feel the stretch, hold the stretch to 20 to 30 seconds and repeat it 3 times.
Active range of motion of the wrist:
Move your wrist up and down in the pain-free range. Repeat 3 sets of 10.
Wrist pain is another topic in itself. I discuss wrist pain and how to manage it here.
Resisted wrist range of motion:
This is performing the range of motion of the wrist as described above with some external weight added to it. Once you are able to perform the range of motion in pain-free range, you can move to perform resisted exercises.
In the picture below, a person is exercising with a dumbbell but you can choose to use other weights like thera bands, wrist barbell.
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Finger Resistance Exercises:
As shown in the pictures below, finger resistance exercises need any external weight to perform finger flexion and extension.
Forearm supination and pronation:
The supination and pronation are rotating the forearm inwards and outwards. The key point here is palm facing downwards and upwards.
Here is a PDF version of the exercises mentioned above for you to print out.