Medial epicondylitis (plural: medial epicondylitides) (also known as golfer's elbow) is an angiofibroblastic tendinosis of the common flexor-pronator tendon group of the elbow.
It is less common than lateral epicondylitis. As with lateral epicondylitis, it typically occurs in the 4th to 5th decades of life. There is no recognized gender predilection.
Patients typically present with insidiously medial elbow pain, swelling and tenderness, particularly over the medial epicondyle. The pain can worsen with wrist flexion and forearm pronation activities. Patients may offer a history of sports activities, including golf, overhead throwing sports, and racket sports. The patient's history may include the occurrence of an acute sports injury or acute trauma.
It is thought to occur from valgus forces transmitted to the medial elbow during forearm pronation and wrist flexion may exceed the strength of the muscles, tendons, and supporting ligaments. Cumulative stress or overuse can lead to tendinosis involving the musculotendinous junction of the flexor-pronator muscle group at the medial epicondyle, with microtrauma and partial tearing that may progress to a full-thickness tendon tear.
Histology demonstrates tendinosis, enthesopathy, disorganization of collagen architecture, mucoid change, fibrosis and variable vascular proliferation.
MR imaging is the most widely used modality for assessment, although ultrasound also may be performed.
Adjacent to the medial epicondyle there may be calcific tendinopathy or enthesopathy.
May be identified as outward bowing, heterogeneous echogenicity, or thickening of the common tendon, with subjacent fluid collection and intratendinous calcification. Discrete tears appear as hypoechoic regions with adjacent tendon discontinuity. Color Doppler may show tendon hyperemia. Dynamic assessment can also be performed to delineate instability.
Described features on MRI include 2:
- thickening and increased signal intensity on both T1 and T2 weighted sequences of the common flexor tendon
- soft tissue edema around the common flexor tendon - peritendonitis
- marrow edema in the medial epicondyle
- muscle atrophy may occur in longstanding cases
Treatment and prognosis
Treatment starts with the application of cold packs to the elbow and oral NSAID therapy. Other clinical approaches include the use of a splint, one or more local corticosteroid injections, application of ultrasound waves and guided rehabilitation program. Surgery is often performed if there is no clinical response after 3 to 6 months of conservative treatment.
For a clinical differential diagnosis of medial elbow pain, consider:
- occult fracture
- medial osteoarthrosis
- medial collateral ligament injury
- 1. Walz DM, Newman JS, Konin GP et-al. Epicondylitis: pathogenesis, imaging, and treatment. Radiographics. 2010;30 (1): 167-84. doi:10.1148/rg.301095078 - Pubmed citation
- 2. Kijowski R, De smet AA. Magnetic resonance imaging findings in patients with medial epicondylitis. Skeletal Radiol. 2005;34 (4): 196-202. doi:10.1007/s00256-005-0896-9 - Pubmed citation
- 3. William Palmer, Laura Bancroft, Fiona Bonar, Jung-Ah Choi, Anne Cotten, James F. Griffith, Philip Robinson, Christian W.A. Pfirrmann. Glossary of terms for musculoskeletal radiology. (2020) Skeletal Radiology. doi:10.1007/s00256-020-03465-1 - Pubmed
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