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Medial Epicondylitis

(Golfer's Elbow)

By Paul L. Liebert, MD, Tomah Memorial Hospital, Tomah, WI

Medial epicondylitis is inflammation of the tendons of the muscles that flex or bend the palm toward the wrist, causing pain on the inner aspect of the elbow and forearm.

  • An activity involving repeated stressful bending of the wrist toward the palm is the usual cause.

  • Rest, ice, and analgesics help relieve pain.

  • When pain subsides, stretching and strengthening exercises are done to help prevent recurrence.

This injury is caused by bending the wrist against resistance toward the palm repetitively (see Figure: When the Elbow Hurts). Actions that produce such force include serving with great force in tennis; using an overhand and a top spin serve; hitting heavy, wet balls; using a racket that is too heavy or that has a grip that is too small or has strings that are too tight; pitching a baseball; and throwing a javelin. Poor technique when hitting the ball in golf can cause this inflammation as well—hence the term golfer’s elbow. Injury occurs when “hitting from the top” and is basically forcefully bringing the club with the right arm (right-handed golfer) down from the top of the swing, placing extreme stress on the flexor muscles of the right elbow instead of pulling down the club with the left arm and the body. Nonathletic activities that may cause medial epicondylitis include bricklaying, hammering, and typing.

Pain is felt on the inner aspect of the elbow and forearm. It is worse when the palm moves toward the wrist.

Diagnosis

  • A doctor's evaluation

Doctors make the diagnosis based on the symptoms and results of an examination. The doctor asks the person to sit in a chair with the injured arm resting on a table, palm up. The doctor holds the wrist down and asks the person to raise the hand by bending the wrist. A person who has medial epicondylitis feels pain at the inner aspect of the elbow.

Treatment

  • Rest

  • Rehabilitation

Initial treatment includes avoiding any activity that causes pain when the wrist is bent toward the palm. Ice applied over the painful area and nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve pain. After pain has decreased, an exercise program that strengthens the wrist and shoulder muscles is begun. Surgery is rarely needed.

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* This is the Consumer Version. *