II. Epidemiology
- Much less common than Lateral Epicondylitis
III. Pathophysiology
-
Tendinopathy (not a Tendonitis)
- The term Tendonitis is a misnomer, as this is a degenerative tendon change, not an inflammatory change
- Flexor forearm Tendinopathy
- Flexor carpi radialis
- Pronator teres
- Repetitive motion injury in sports and manual labor
- Repetitive flexion with valgus stress at the elbow
- Repetitive wrist flexion and pronation
- More common in baseball pitchers and golfers
- Also more common with the forehand in tennis
- Contrast with the tennis backhand affecting Lateral Epicondylitis)
IV. Symptoms
- Dull ache at medial epicondyle
- Gradual onset of pain
- Pain radiates into Forearm
- Grip strength weakness
V. Signs
- Maximum tenderness localized within 1 cm distal and anterior to the medial epicondyle
- Provocative maneuvers eliciting pain
- Wrist flexion against resistance
- Forearm pronation against resistance (best Test Sensitivity for Medial Epicondylitis)
VI. Management: Initial
- See RICE-M
- Relative rest of Forearm pronators and wrist flexors
- Avoid repetitive motion activities
- Counterforce bracing
- Pad positioned over the proximal and medial Forearm (over the flexor-pronator complex)
- Variable evidence (see Lateral Epicondylitis)
-
Wrist Splint
- Indicated for severe medial epicondyliytis symptoms
-
Elbow extension splint
- Indicated for comorbid Ulnar Neuropathy
- Splint at 30-45 degrees elbow flexion
- Worn only overnight
VII. Management: Rehabilitation
- Start after 1-6 weeks of initial therapy, and when free of pain on wrist flexion and Forearm pronation
- Step 1
- Start with gentle flexor and pronator stretches
- Step 2
- Advance to Isometric Exercises and then to Eccentric Exercises
VIII. Resources
- EMedicine Physical Medicine and Rehabilitation for Epicondylitis