Golfers elbow (medial epicondylitis) is caused by repetitive microtrauma to the flexor and pronator mass tendon insertion at the elbow joint and it is due to eccentric overloading of the tendinous mass. It is less common than Tennis elbow and is usually the dominant arm that is affected.

Medial aspect of right forearm

Mechanism of injury:

• Most commonly overuse strain to arm on the medal side
• Local trauma to medial side of elbow
• Risk factors include throwing sports

Presentation:

• Pain
• Swelling
• Deformity
• Inability to flex and extend the elbow with pain that worsens with activity
• Multiple joint arthralgia when cause due to an inflammatory cause

Clinical:

• Localized tenderness near the insertion of common flexor tendon
• Provocative test: resisted forearm pronation and wrist flexion evokes the medial elbow pain
• Assess elbow stability and exclude ulnar neuritis

Investigation:

• X-rays: AP, Greenspan and lateral views usually unremarkable. Occasional calcification may be seen.
• Ultrasound: tendinous tears and areas of degeneration with hypoechoic signal change at sonography
• MRI scan: tendon and peritendon oedema, useful to exclude associated elbow instability

Non-operative:

• Rest
• Athlete activity modification is necessary while rehabilitating
• Non-steroidal anti-inflammatory medication (NSAIDs)
• Arm counter-force bracing
• Kinesiology taping
• Extracorporeal shockwave therapy
• Local anaesthetic and steroid injection (LASI)

Surgery:

• Failed conservative management for 6 months

Surgery options:

• Debridement of flexor-pronator mass with reattachment

Counter-force elbow brace

Forearm strength exercise

Stretching Flexor Forearm Compartment

Medial 3-4 cm incision across medial epicondyle

Structures at risk Ulnar nerve posterior to medial epicondyle

• Medial approach to medial epicondyle
• Debride necrotic tissue
• Reattachment and fixation of common flexor-pronator muscle
• Closure

Arm sling

Hand grip exercises

Stretching flexor forearm compartment