Medial/Lateral Epicondylitis of the Elbow

Medial Epicondylitis

Golfer’s elbow, also called Medial Epicondylitis, is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and microtears in the tendons that attach to the medial epicondyle. The medial epicondyle is the bony prominence that is felt on the inside of the elbow.

Golfer’s elbow and Tennis Elbow are similar except that Golfer’s elbow occurs on the inside of the elbow and Tennis Elbow occurs on the outside of the elbow. Both conditions are a type of Tendonitis which literally means “inflammation of the tendons”.

Signs and symptoms

Signs and symptoms of Golfer’s Elbow can include the following:

Elbow pain that appears suddenly or gradually
Achy pain to the inner side of the elbow during activity
Elbow stiffness with decreased range of motion
Pain may radiate to the inner forearm, hand or wrist
Weakened grip
Pain worsens with gripping objects
Pain is exacerbated in the elbow when the wrist is flexed or bent forward toward the forearm

Causes

Golfer’s Elbow is usually caused by overuse of the forearm muscles and tendons that control wrist and finger movement but may also be caused by direct trauma such as with a fall, car accident, or work injury.

Golfer’s elbow is commonly seen in golfer’s, hence the name, especially when poor technique or unsuitable equipment is used when hitting the ball. Other common causes include any activity that requires repetitive motion of the forearm such as: painting, hammering, typing, raking, pitching sports, gardening, shoveling, fencing, and playing golf.

Diagnosis

Golfer’s Elbow should be evaluated by an orthopedic specialist for proper diagnosis and treatment.

Medical History
Physical Examination
Your physician may order an x-ray to rule out a fracture or arthritis as the cause of your pain.
Occasionally, if the diagnosis is unclear, your physician may order further tests to confirm golfer’s elbow such as MRI, ultrasonography, and injection test

Conservative Treatment Options

Your physician will recommend conservative treatment options to treat the symptoms associated with Golfer’s Elbow. These may include the following:

Activity Restrictions: Limit use and rest the arm from activities that worsen symptoms
Orthotics: Splints or braces may be ordered to decrease stress on the injured tissues
Ice: Ice packs applied to the injury will help diminish swelling and pain. Ice should be applied over a towel to the affected area for 20 minutes four times a day for a couple days. Never place ice directly over the skin
Medications: Anti-inflammatory medications and/or steroid injections may be ordered to treat the pain and swelling
Occupational Therapy: OT may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased
Pulsed Ultrasound: A non-invasive treatment used by therapists to break up scar tissue and increase blood flow to the injured tendons to promote healing
Professional instruction: Consulting with a sports professional to assess and instruct in proper swing technique and appropriate equipment may be recommended to prevent recurrence

Surgery

If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend surgery to treat Golfers Elbow. The goal of surgery to treat Golfers Elbow is to remove the diseased tissue around the inner elbow, improve blood supply to the area to promote healing, and alleviate the patient’s symptoms.

Lateral Epicondylitis

Tennis elbow is the common name used for the elbow condition called lateral epicondylitis. It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow (lateral epicondyle). It is a painful condition occurring from repeated muscle contractions at the forearm that leads to inflammation and micro tears in the tendons that attach to the lateral epicondyle. The condition is more common in sports activities such as tennis, painting, hammering, typing, gardening and playing musical instruments. Patients with tennis elbow experience elbow pain or burning that gradually worsens and a weakened grip

Your doctor will evaluate tennis elbow by reviewing your medical history, performing a thorough physical examination and ordering X-rays, MRI or electromyogram (EMG) to detect any nerve compression.

Your doctor will first recommend conservative treatment options to treat the tennis elbow symptoms. These may include:

Limit use and rest the arm from activities that worsen symptoms.
Splints or braces may be ordered to decrease stress on the injured tissues.
Apply ice packs on the elbow to reduce swelling.
Avoid activities that bring on the symptoms and increase stress on the tendons.
Anti-inflammatory medications and/or steroid injections may be ordered to treat pain and swelling.
Physical therapy may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased.
Pulsed ultrasound may be utilized to increase blood flow and promote healing to the injured tendons.

If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend a surgical procedure to treat tennis elbow called lateral epicondyle release surgery. Your surgeon will decide whether to perform your surgery in the traditional open manner (single large incision) or endoscopically (2 to 3 tiny incisions and the use of an endoscope –narrow lighted tube with a camera). Your surgeon will decide which options are best for you depending on your specific circumstances.

Your surgeon moves aside soft tissue to view the extensor tendon and its attachment on the lateral epicondyle. The surgeon then trims the tendon or releases the tendon and then reattaches it to the bone. Any scar tissue present will be removed as well as any bone spurs. After the surgery is completed, the incision(s) are closed by suturing or by tape.

Following surgery, you are referred to physical therapy to improve the range of motion and strength of your joint.