Medial epicondylitis, commonly called golfer’s elbow, is degeneration of the tendon attachment of the wrist flexor and forearm pronator muscles to the medial epicondyle on the inside of the elbow. The condition develops from repetitive use rather than a single injury and produces pain on the inside of the elbow, particularly with gripping, lifting, and wrist flexion. Most cases resolve with non-surgical treatment, though refractory cases benefit from surgical debridement.
What Is Medial Epicondylitis?
The medial epicondyle is the bony prominence on the inside of the elbow where the wrist flexor and forearm pronator muscles attach via a common tendon. Repetitive gripping, wrist flexion, and forearm pronation load this tendon, and chronic overload produces tendinosis (degenerative changes) rather than acute inflammation. The term tendinitis is often used clinically, but the underlying problem is degeneration without active inflammation in most cases.
The pronator teres and flexor carpi radialis tendons are most commonly affected. The ulnar nerve runs nearby and is often involved as a secondary problem.
Causes and Risk Factors
- Repetitive gripping and wrist flexion in sports (golf, tennis, baseball pitching, throwing)
- Heavy manual labor with repetitive forearm use (carpenters, plumbers, mechanics)
- Sudden increase in training volume or intensity
- Improper sport technique that increases medial elbow stress
- Age 35 to 55 is the most common demographic
- Smoking and diabetes, both of which are associated with tendon degeneration
Symptoms
- Pain on the inside of the elbow, often gradual in onset
- Tenderness at the medial epicondyle
- Pain reproduced with resisted wrist flexion or forearm pronation
- Weakness with gripping
- Pain with lifting heavy objects, opening jars, or shaking hands
- Occasional numbness or tingling in the ring and small fingers if the ulnar nerve is involved
Diagnosis
Dr. Chudik’s evaluation includes the activity pattern, occupational history, and a focused examination. Tenderness localized to the medial epicondyle, pain with resisted wrist flexion or pronation, and ulnar nerve testing are the key findings. X-rays evaluate for calcifications or arthritic changes. MRI is ordered when the diagnosis is unclear or when ulnar collateral ligament injury or ulnar nerve compression is suspected. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment resolves the majority of cases. Components include:
- Activity modification to reduce provocative loading
- A counterforce brace (forearm strap) to redistribute tendon load
- Anti-inflammatory medication for pain control
- A targeted physical therapy program emphasizing eccentric strengthening of the wrist flexors and forearm conditioning
- Corticosteroid injection in select cases for short-term relief, though injection is avoided in chronic tendinosis as it can weaken the tendon
- Platelet-rich plasma (PRP) injection in refractory cases as a biologic alternative
For cases that fail six to 12 months of non-surgical treatment, Dr. Chudik performs surgical debridement, removing the degenerative tendon tissue and stimulating healing. The procedure is typically performed open through a small medial incision.
Recovery and Outcomes
Non-surgical recovery typically requires three to six months of dedicated treatment. Outcomes are good when activity modification and eccentric strengthening are completed.
Recovery after surgical debridement typically includes two to three weeks of brace protection, progressive motion and strengthening over three months, and return to full activity at four to six months. Outcomes after surgery are good for refractory cases.
When to See Dr. Chudik
Schedule an evaluation if medial elbow pain has persisted beyond six weeks of activity modification, if it interferes with sport or work, or if there are associated nerve symptoms in the hand. Call 630-324-0402 or request an appointment online.