Updated: 12/23/2017

Medial and Lateral Epicondylitis

Topic
Review Topic
0
0
Snapshot
  • A 25-year-old man presents to his primary care physician due to elbow pain. He reports that the pain affects his right arm and is located in the right aspect of the elbow. He says that the pain is typically a 3/10 at baseline but increases to an 8/10 when playing badminton or squash. On physical exam, there is tenderness upon palpation of the lateral epicondyle, as well as pain with resisted wrist extension while the elbow is fully extended.
Introduction
  • Pathoanatomy
    • distal humerus
      • contains both the medial and lateral epicondyle, which serves as the origin site for wrist flexors and extensors
        • medial epicondyle
          • origin site for wrist flexors
        • lateral epicondyle
          • origin site for wrist extensors
    • microscopic analysis of the affected tendon demonstrates an angiofibroblastic degeneration and collagen disarray 
      • there are no signs of inflammation as this is an overuse syndrome
  • Clinical definition
    • medial epicondylitis
      • overuse injury affecting the wrist flexor tendons that originate in the medial epicondyle
        • pronator teres and flexor carpi radialis muscle are injured
      • also known as "golfer's elbow"
    • lateral epicondylitis
      • overuse injury affecting the wrist extensor tendons that originate in the lateral epicondyle
        • extensor carpi radialis brevis muscle (more common) and the extensor digitorum communis muscle (occasionally) are injured
      • also known as "tennis elbow"
      • lateral epicondylitis is much more common than medial epicondylitis

Repetitive Elbow Trauma
Category
Mechanism
Presentation Management
Medial epicondylitis
  • Excessive wrist flexion activities
  • Symptoms
    • medial elbow pain
  • Physical exam
    • tenderness palpation of the medial epicondyle
    • pain with
      • resisted wrist flexion while the elbow is extended
      • passive wrist extension while the elbow is extended
  • Activity modification
    • avoiding exacerbating activities
  • Physical therapy
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
Lateral epicondylitis
  • Excessive wrist extension activities
  • Symptoms
    • lateral elbow pain
  • Physical exam
    • tenderness upon palpation of the lateral epicondyle
    • pain with
      • resisted wrist extension while the elbow is extended
      • passive wrist flexion while the elbow is extended
  • Activity modification
    • avoiding exacerbating activities
  • Counterforce brace
  • Physical therapy
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
Medial epicondylitis is much less common than lateral
epicondylitis and typically occurs in athletes or workers
who participate in activities that involve repetitive valgus
stress and flexion at the elbow, as well as repetitive wrist
flexion and pronation. It is a tendinopathy of the common
flexor tendon, usually the flexor carpi radialis and
the pronator teres.1
 

Please rate topic.

Average 5.0 of 2 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (0)
Private Note