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Medial Epicondylitis Tenderness with Resisted Wrist Flexion

Exams and Signs

Historical Overview

  • Medial epicondylitis is also described as “golfer’s elbow.”

Description

  • Patients usually experience medial epicondyle tenderness and/or pain anterior and distal to the anterior midpoint of the medial epicondyle of the pronator teres (PT) and flexor carpi radialis (FCR).1
  • With medial epicondylitis, resisted pronation of the forearm with the wrist in flexion often causes pain.

Pathophysiology

  • During activities of wrist flexion and forearm pronation, flexor-pronator degeneration occurs with forced wrist extension and forearm supination.2
  • Medial epicondylitis is the result of an angiofibroblastic response, not of an inflammatory process. This response may result from microtrauma of the FCR and the PT tendons, with an incomplete reparative response. 1
  • In rare cases, medial epicondyle tenderness may be caused by a medial ulnar collateral ligament injury. When this ligament is disturbed, unusual stress is placed on the articular surfaces, which may change osteophyte formation.3

Instructions

  1. Record the patient’s history, including any sports-related injuries.
  2. Ask the patient to rate his/her pain on a scale from 1-10, s/he usually experiences in the affected elbow.
  3. While the patient is bending the wrist in palmar flexion, use one hand to palpate the medial epicondyle, approximately 5-10 mm anterior and distal to the anterior midpoint of the medial epicondyle of the PT and FCR.1
  4. Ask the patient to make a fist against the resistance of your other hand.
  5. Check whether this resistance intensifies the tenderness and/or pain.
  6. Examine the medial epicondyle on the contralateral side, with resisted wrist flexion, for comparison.

Related Signs and Tests

  • Medial epicondyle tenderness
  • Lateral epicondyle tenderness
  • Ulnar neurovascular exam
  • Radiographs
  • Magnetic resonance imaging (MRI) and ultrasound

Diagnostic Performance Characteristics

  • To improve reliability, palpate the medial epicondyle from various directions.
  • Do not use other patients’ reactions as a comparison, because other patients may have different perceptions of similar tenderness and/or pain.

Additional Information

Presentation Photos and Related Diagrams
  • Palpating medial epicondyle for point tenderness without resisted wrist.
    Palpating medial epicondyle for point tenderness without resisted wrist.
  • Palpating medial epicondyle for point tenderness while resisting wrist flexion
    Palpating medial epicondyle for point tenderness while resisting wrist flexion
Definition of Positive Result
  • A positive result occurs when a patient experiences tenderness with pressure. 
Definition of Negative Result
  • A negative result occurs when a patient does not experience tenderness with pressure. 
Comments and Pearls
  • Treatment for medial epicondylitis may include corticosteroid injections. Once severe symptoms are alleviated, focus shifts to flexor-pronator mass rehabilitation and injury prevention.2
  • If corticosteroid injections are unsuccessful, an exercise regimen may help to improve strength and flexibility.1
Diagnoses Associated with Exams and Signs
References
  1. Culp R, Jacoby S.  Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012.
  2. Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg 2015;23(6):348-55. PMID: 26001427
  3. Field LD, Savoie FH. Common elbow injuries in sport. Sports Med 1998;26(3):193-205. PMID: 9802175
  4. Taylor SA, Hannafin JA. Evaluation and Management of Elbow Tendinopathy. Sports Health 2012;4(5):384-93. PMID: 23016111
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