Medial Epicondylitis aka. Golfers/Baseball Elbow

  • 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

  • Epiphesial injuries

  • 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

  1. 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.

  2. 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