II. Epidemiology

  1. Much less common than Lateral Epicondylitis

III. Pathophysiology

  1. Tendinopathy (not a Tendonitis)
    1. The term Tendonitis is a misnomer, as this is a degenerative tendon change, not an inflammatory change
  2. Flexor forearm Tendinopathy
    1. Flexor carpi radialis
    2. Pronator teres
  3. Repetitive motion injury in sports and manual labor
    1. Repetitive flexion with valgus stress at the elbow
    2. repetitive wrist flexion and pronation

IV. Symptoms

  1. Dull ache at medial epicondyle
  2. Gradual onset of pain
  3. Pain radiates into Forearm
  4. Grip strength weakness

V. Signs

  1. Maximum tenderness localized within 1 cm distal and anterior to the medial epicondyle
  2. Provocative maneuvers eliciting pain
    1. Wrist flexion against resistance
    2. Forearm pronation against resistance (best Test Sensitivity for Medial Epicondylitis)

VI. Management: Initial

  1. See RICE-M
  2. Relative rest of Forearm pronators and wrist flexors
    1. Avoid repetitive motion activities
  3. Counterforce bracing
    1. Pad positioned over the proximal and medial Forearm (over the flexor-pronator complex)
    2. Variable evidence (see Lateral Epicondylitis)
  4. Wrist Splint
    1. Indicated for severe medial epicondyliytis symptoms
  5. Elbow extension splint
    1. Indicated for comorbid Ulnar Neuropathy
    2. Splint at 30-45 degrees elbow flexion
    3. Worn only overnight

VII. Management: Rehabilitation

  1. Start after 1-6 weeks of initial therapy, and when free of pain on wrist flexion and Forearm pronation
  2. Step 1
    1. Start with gentle flexor and pronator stretches
  3. Step 2
    1. Advance to Isometric Exercises and then to Eccentric Exercises

VIII. Resources

  1. EMedicine Physical Medicine and Rehabilitation for Epicondylitis
    1. http://emedicine.medscape.com/article/327860-overview#showall

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