Medial epicondylitis, otherwise known as golfers/baseball elbow is an injury that affects the tendons of the flexor musculature of the forearm.
Degeneration begins to occur of the flexor and pronator muscle tendons, which insert onto the inside of your elbow- where the pain is commonly most felt. This area is called the medial epicondyle of the humerus bone, hence the name given to the injury. There are 5 different muscles that attach to this one spot!
More commonly, you may have heard of ‘tennis elbow’, which is 3-10 times more common- affecting the outside of the elbow as opposed to the inside.
Causes
As with tendon-based injuries, the most common cause of medial epicondylitis is overload of the area.
This often involves an unusual increase in a throwing/gripping (or golfing!) activity where these particular muscles are required to work a lot. Day to day activities and common occupations may include those that are quite labour intensive and require a lot of repetitive loading of the forearms.
In throwing sports such as baseball or cricket, the technique used to throw the ball can often also be a factor- particularly the ‘sling’ action adopted in baseball when pitching. This is referred to as increased ‘varus’ force due to the way the elbow becomes positioned.
Signs & Symptoms
Pain located on the inside on the elbow- and sometimes down into the inside of the forearm and into the hand.
The ulnar nerve has a little groove it sits in on the inside of your elbow- (the nerve you hit when you hit your funny bone!), which can sometimes become irritated causing neural symptoms. This can include pins and needles into the forearm and hand.
Loss of power and strength- particularly when gripping and holding objects.
Differential Diagnosis
Medial collateral ligament injury
Pronator quadratus syndrome
Nerve entrapment
Referred pain from cervical spine
How to Manage
After confirming the diagnosis, together with your PROmotion physiotherapist, an individualised treatment plan will be formulated. This will be in line with your particular goals of rehabilitation.
Current evidence suggests that for tendon based injuries- exercise based interventions are currently front line treatments. This will involve exercises targeting certain muscles and movements to strengthen particular areas.
Load management is also key to these types of injuries- this may look like reducing your ‘load’ (ie throwing/golfing) to help the inflammatory component settle down and then build things back up.
Manual therapy for Medial Epicondylitis often involves soft tissue massage, trigger point release, dry needling, mobilisations and some taping techniques to help with symptomatic relief.
In some causes, anti-inflammatory medication or extracorporeal shock wave therapy may be indicated.
References
Hudes K. (2011). Conservative management of a case of medial epicondylosis in a recreational squash player. The Journal of the Canadian Chiropractic Association, 55(1), 26–31.
Ciccotti, M. C., Schwartz, M. A., & Ciccotti, M. G. (2004). Diagnosis and treatment of medial epicondylitis of the elbow. Clinics in sports medicine, 23(4), 693–xi. https://doi.org/10.1016/j.csm.2004.04.011
