Elbow
Medial Epicondylitis (Golfer's Elbow)
내측 상과염
Flexor-pronator tendinopathy at the medial epicondyle — Golfer's Elbow
- How common
- Common
- Typical age
- Ages 30–60
What is it?
Degenerative changes at medial epicondyle attachment of pronator teres and flexor carpi radialis (FCR) tendons
Commonly affected: Common flexor origin (FCR, FCU, pronator teres, FDS), ulnar nerve (20% concurrent)
How it develops
- Flexion-Pronation OverloadRepetitive wrist flexion and forearm pronation (golf, throwing, racket sports) increase medial epicondyle stress
- Tendon MicrotearsMicrotears at common flexor origin (FCR, FCU, pronator teres)
- Angiofibroblastic TendinosisSimilar to lateral epicondylitis — angiofibroblastic degeneration
- Ulnar Nerve IrritationUlnar nerve posterior to medial epicondyle — inflammation may cause neurological symptoms (20%)
Symptoms
- Medial Epicondyle PainLocalized tenderness and pain at medial epicondyle, may radiate down medial forearm
- Flexion/Pronation PainMedial epicondyle pain worsens with wrist flexion, forearm pronation, hand gripping
- 4th-5th Finger NumbnessUlnar nerve irritation causes ring-little finger numbness (ulnar sensory distribution)
- Grip WeaknessReduced grip strength due to pain avoidance
How it is examined
- Medial Epicondyle TendernessTenderness at 5-10mm distal to medial epicondyle (common flexor origin)
- Resisted Wrist FlexionResisted wrist flexion reproduces medial epicondyle pain → Positive
- Ulnar Nerve Tinel's TestTapping ulnar nerve at medial elbow causes ring-little finger tingling → concurrent ulnar nerve irritation
- Elbow Flexion TestFull elbow flexion with wrist extension held for 30 seconds — ulnar nerve tension test
Imaging
Usually normal. Chronic cases may show medial epicondyle calcification or osteophytes
- Usually normal
- Chronic: medial epicondyle calcification
- Medial elbow osteophyte (rare)
Assess tendon damage and concurrent ulnar collateral ligament (UCL) injury
- Common flexor origin T2 hyperintensity (tendinosis)
- Concurrent UCL injury assessment
- Periulnar nerve changes
Non-surgical care
- Activity Modification and RICERest during acute phase, avoid provoking activities
- Physical TherapyEccentric exercise, forearm flexor-pronator stretching and strengthening
- Steroid InjectionShort-term pain relief injection at medial epicondyle — beware ulnar nerve
- Ulnar Nerve DecompressionConsider nerve decompression when ulnar nerve symptoms are present
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed conservative treatment 6-12 months, persistent ulnar nerve symptoms
Procedures that may be discussed
- Common flexor origin release
- Ulnar nerve anterior transposition (with UCL injury)
- Open or arthroscopic surgery
Outlook
Slightly worse prognosis than lateral epicondylitis. 80-85% improve with conservative treatment. 6-18 months for recovery