Medial Epicondylitis


What is medial epicondylitis?

Medial epicomdylitis is the medical condition where tenderness and pain is generated inside the lower arm close to the elbow joint. The medial epicondylitis is commonly known as golfer’s elbow.

medial epicondylitis

In chronic condition the pain extends up to wrist. In medial epicondylitis, damage occurs in the tendon which is attached with the muscle that helps to bending the wrist and fingers and the bone, which connected with inner part of the elbow (medial epicondyl).


Symptoms of medial epicondylitis

Following are the common features of the medial epicondylitis:

  • Pain and tenderness found at the inner side of the elbow and it may extend up to forearm involving wrist joint. In severe case the mobility of hand becomes restricted. The onset of pain may be sudden or gradual. Some activities, such as weight lifting, tennis or any racket sports, hand shake, open the door with twisting the door knob increase the pain intensity.
  • Increase stiffness in the elbow joint causes limits the gripping power and difficult to make fist
  • Hand, including wrist strength becomes lower and difficult to perform work due to weakness
  • Tingling sensation may generate at in the one or more fingers. The numbness mainly feel at the little and ring finger.

Causes

Excessive use of the forearm muscle, elbow and associated tendon is responsible for development of the medial epicondylitis. Some daily activities like gardening, hammering nails or shovelling need frequent movement of the hand and increase strain in the forearm muscle and tendons. Even swimming also need repatetive hand movement and to increase speed, they they increase strain in the flexor tendon which is present in the elbow.

In some cases medial epicondylitis, is the result of injury which develops inflammation. During injury, the tissues of tendon become damaged and medically termed as tendonosis. Tendonosis leads to degeneration of tissue and causes anomaly in collagen fibers arrangement.

Often it has been seen that fibroblasts are generated due to collagen tissue degeneration and loses its strength. This causes injury and breakage during any trauma. The fragile collagen is responsible for scar formation in the tendon and become thickened and reparative strain causes delayed healing and generated injury never become healed up and causes pain and gradual weakness.

The extreme force used to twist the wrist towards the palm during golf or baseball playing causes the medial epicondylitis. Other possible causes which may contribute for development of the medial epicondylitis are as follows:

  • In tennis, during spine serve or serving with heavy force.
  • Shoulder and wrist muscle weakness
  • Throwing with great force
  • Carriage of heavy luggage
  • Wood cutting with Axe
  • Using of frequent saw
  • Any machine which is operated by hand with great effort.

Treatment

The treatment of medial epicondylitis has two approaches:

  • Non-surgical treatment
  • Surgical treatment

NON-SURGICAL TREATMENT

The aim of the non- surgical treatment is to heal the tendon.

Medications

For reduction of inflammation, the different non-steroidal anti-inflammatory drugs are prescribed for oral administration with certain period of time. If the inflammation is not cured then stop taking non-steroidal anti-inflammatory drugs for long term, as they have side effects like renal failure, stomach irritation etc.

Further medical treatment allows providing steroidal injection at the site of bursa. They provide prompt relief from pain, but duration of action maximum last for a week, so usual injection is provided weekly. Due to several side effects, they are avoided for long term use.

Physical therapy

The effectiveness of this therapy is usually depends upon the skill and experience of the therapist. Initially different postural tips are given for release the excessive strain. Elbow straps wrap up around the bellow portion of the elbow joint also beneficial for releasing the pressure from attached tendon which is attached with the joint.

Other possible physical therapy includes cold compression with ice and electrical stimulation for reduction of pain and augments the curing of the collagen. For easy reaching to the anti-inflammatory medicine to the affected bursa, mild electric current passes at the swelled area of the knee. This method is known as iontophoresis.

Shock wave therapy is applied shock into affected area through a machine. Usually the therapy is applied once in a week. The mechanism of action of this therapy has not any scientific background. But this therapy is useful for reduce pain and also improve the mobility and functionality of the forearm.

Other than this proper training before sports activity is very important t o reduce the tendonosis, so proper skilled and experienced trainer is required for sports activities.

Surgical treatment

If non surgical treatments fail to provide relief from pain, then surgical interventions are recommended by the doctor.

Tendon debridement

If tendonosis is the reason of development of the medial epicondylitis, then debride means the affected tissues are taking out from the tendon can improve the pain condition and for this surgical intervention is one of the successful method.

Medial epicondyle release

The aim of this surgery is helps to release the tension from the flexor tendon. In this surgery, one incision is conducted over the medial epicondyle for cut the junction, where flexon tendon connects with medial epicondyle and also removes the surrounded injured tissues and bone spurs.  Almost after six weeks of surgery, patient gets his normal activity.

Exercise

The following exercises are beneficial for medial epicondylitis, but it is always recommended before starts any stretching exercise discuss it with doctor and take proper guidance from physiotherapist. Any increase symptoms need to stop the exercises.

Stretching of elbow

First straighten the affected elbow. Now palm should be downwards and front facing. Hold the wrist and stretch with another hand. Hold the pressure for 12 seconds and repeat this 5 times.

Squeezing of Tennis ball

Hold a tennis ball in affected hand palm and then grip it tightly. Then as much as you can provide pressure during squeezing the ball without producing any pain should provide and continue for 30 seconds, then release pressure and repeat this 10 times a day.

References

  1. http://www.mayoclinic.org/diseases-conditions/golfers-elbow/basics/definition/con-20027964
  2. https://www.nlm.nih.gov/medlineplus/ency/article/007638.htm
  3. Medial Epicondylitis (Golfer’s and Baseball Elbow) at http://www.hopkinsmedicine.org/healthlibrary/conditions/orthopaedic_disorders/medial_epicondylitis_golfers_and_baseball_elbow_85,P00928/
  4. A PATIENT’S GUIDE TO MEDIAL EPICONDYLITIS (GOLFER’S ELBOW) surgery, diagnosis, symptoms, causes at http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/elbow/medial-epicondylitis-golfers-elbow/
  5. http://emedicine.medscape.com/article/97217-overview
  6. http://emedicine.medscape.com/article/327860-overview
  7. http://www.physioadvisor.com.au/9256850/golfers-elbow-medial-epicondylitis-physioadvis.htm

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