Medial Epicondylitis

(Golfer's Elbow)

ByPaul L. Liebert, MD, Tomah Memorial Hospital, Tomah, WI
Reviewed/Revised Nov 2023
VIEW PROFESSIONAL VERSION

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.

(See also Overview of Sports Injuries.)

  • 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 of Medial Epicondylitis

  • 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 of Medial Epicondylitis

  • 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.

Exercises to Strengthen Wrist and Shoulder Muscles
Wrist Extensor Stretch
Wrist Extensor Stretch
1. Begin with the elbow straight, palm down. 2. With the uninvolved hand, grasp thumb side of hand and bend wrist downw... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

Wrist Flexor Stretch
Wrist Flexor Stretch
1. Position involved hand palm up. 2. Grasp fingers on involved hand with the other hand. 3. Keep elbow straight on inv... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

Resisted Wrist Extension With Weight
Resisted Wrist Extension With Weight
1. Place forearm on table with the hand palm down, off the edge of the table. 2. Move wrist up into extension. 3. Slowl... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

Resisted Hand and Finger Gripping With Towel
Resisted Hand and Finger Gripping With Towel
1. Grasp and gently squeeze towel roll with both hands. 2. Twist towel in alternating directions. 3. Do 3 sets of 10 r... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

Resisted Finger Abduction and Extension With Putty
Resisted Finger Abduction and Extension With Putty
1. Flatten putty on table. 2. Curl (flex) fingers and place on putty. 3. Straighten and spread fingers, pushing into pu... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

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