Medial Epicondylitis

Tendinopathy (not a Tendonitis)
1. The term Tendonitis is a misnomer, as this is a degenerative tendon change, not an inflammatory change
Flexor forearm Tendinopathy
1. Flexor carpi radialis
2. Pronator teres
Repetitive motion injury in sports and manual labor
1. Repetitive flexion with valgus stress at the elbow
2. Repetitive wrist flexion and pronation
3. More common in baseball pitchers and golfers
4. Also more common with the forehand in tennis
  1. Contrast with the tennis backhand affecting Lateral Epicondylitis)

Maximum tenderness localized within 1 cm distal and anterior to the medial epicondyle
Provocative maneuvers eliciting pain
1. Wrist flexion against resistance
2. Forearm pronation against resistance (best Test Sensitivity for Medial Epicondylitis)

See RICE-M
Relative rest of Forearm pronators and wrist flexors
1. Avoid repetitive motion activities
Counterforce bracing
1. Pad positioned over the proximal and medial Forearm (over the flexor-pronator complex)
2. Variable evidence (see Lateral Epicondylitis)
Wrist Splint
1. Indicated for severe medial epicondyliytis symptoms
Elbow extension splint
1. Indicated for comorbid Ulnar Neuropathy
2. Splint at 30-45 degrees elbow flexion
3. Worn only overnight

Start after 1-6 weeks of initial therapy, and when free of pain on wrist flexion and Forearm pronation
Step 1
1. Start with gentle flexor and pronator stretches
Step 2
1. Advance to Isometric Exercises and then to Eccentric Exercises