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Degenerative Condition

Golfer's Elbow

Medial Epicondylitis

Expert information on diagnosis, treatment, and recovery from medial epicondylitis

Understanding Golfer's Elbow

Golfer's elbow is less common than tennis elbow, occurring at a ratio of approximately 1:7. It affects the flexor-pronator muscle group that originates from the medial epicondyle of the humerus.

Epidemiology

  • • Prevalence: 0.3-0.6% of general population
  • • Peak age: 40-60 years
  • • Dominant arm most commonly affected
  • • Common in golfers, throwing athletes, and manual workers
  • • Associated with occupational repetitive tasks

The condition involves degeneration of the flexor-pronator origin, particularly the pronator teres and flexor carpi radialis tendons. Unlike inflammation, this is a degenerative process with angiofibroblastic changes similar to tennis elbow.

Important: Ulnar Nerve Involvement

Up to 50% of patients have concurrent ulnar neuropathy due to the nerve's proximity. Always assess for tingling in the ring and small fingers, and weakness of intrinsic hand muscles.

Causes & Risk Factors

Sports Activities

• Golf (improper swing mechanics)

• Throwing sports (baseball, javelin)

• Racquet sports (forehand strokes)

• Weightlifting (especially curls)

• Climbing

Occupational Activities

• Carpentry and construction

• Plumbing

• Repetitive computer use

• Assembly line work

• Meat cutting/butchery

Symptoms & Diagnosis

Common Symptoms

Pain over medial epicondyle (inner elbow)
Pain radiating into forearm
Weakness with gripping
Pain with wrist flexion and pronation
Morning stiffness
Tingling in ring/small fingers (if ulnar nerve involved)

Clinical Tests

Medial Epicondyle Palpation

Point tenderness over medial epicondyle and 5mm distal

Resisted Wrist Flexion

Pain with resisted wrist flexion, elbow extended

Resisted Pronation

Pain with resisted forearm pronation

Tinel's Test at Elbow

Assess for ulnar nerve involvement

Treatment Options

Conservative treatment is successful in the vast majority of cases

Conservative Treatment (First Line)

Rest and Activity Modification

Avoid aggravating activities, modify grip size, correct technique

Counterforce Bracing

Strap worn just distal to medial epicondyle reduces muscle tension

Eccentric Exercises

Progressive eccentric wrist flexion exercises - cornerstone of rehabilitation

NSAIDs & Ice

For symptom relief during acute phase

Surgical Treatment (Rarely Needed)

Reserved for persistent symptoms after 6-12 months of conservative treatment

Debridement of Degenerative Tissue

Open or arthroscopic excision of angiofibroblastic tissue

Ulnar Nerve Decompression

May be performed concurrently if ulnar nerve symptoms present

Success Rate: 80-90% good to excellent results with surgical treatment

Evidence & References

• Ciccotti MC, Schwartz MA, Ciccotti MG. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med 2004

• Vangsness CT Jr, Jobe FW. Surgical treatment of medial epicondylitis. Results in 35 elbows. JBJS 1991

• Gabel GT, Morrey BF. Operative treatment of medial epicondylitis. JBJS 1995

Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)

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