Medial Elbow Tendinopathy (Golfer’s Elbow)

Disclaimer: Please read the Disclaimer at the bottom of this page.
Copyright © Educom Pty Ltd: All material on this website (including the text, graphics, videos and downloadable files) is owned by or licensed to Educom Pty Ltd and is subject to copyright and other intellectual property rights under international conventions

Medial Elbow Tendinopathy (Golfer’s Elbow)

Medial elbow tendinopathy has historically been referred to as ‘Golfer’s Elbow’ and medial epicondylitis. It is sometimes also referred to as elbow tendinosis, elbow tendonitis, and medial epicondylalgia. It is also known as ‘Pitcher’s Elbow’, particularly in North America. This condition is similar to lateral elbow tendinopathy (‘Tennis Elbow’) but affects the flexor-pronator origin on the medial epicondyle of the elbow.

Although it is most commonly referred to as ‘Golfer’s Elbow’, it is more commonly associated with baseball pitching. It is also reported in other sporting activities such as archery and weightlifting. However, it is noteworthy that approximately 90% of cases occur outside of sports in occupations such as carpentry and catering.

Medial elbow tendinopathy most commonly arises between the age of 50 and 70, is more frequently found in women, and 75% of cases involve the dominant arm. The tendons of the flexor carpi radialis and the pronator teres are most commonly involved. Recent research has identified that medial elbow tendinopathy represents chronic tendinosis, with microscopic examination revealing angiofibroblastic degeneration rather than an inflammatory process at the site of pathology. As such, this condition should not be referred to as ‘epicondylitis’.

The mechanism of injury involves repetitive motions of the wrist which causes the muscles and their tendons to undergo rapid and forceful lengthening while under load. Once the injury has occurred, the performance of subsequent strenuous or exaggerated movements increases the risk of further damage to the degenerative or disorganized tissue.

Risk Factors

• Smoking
• Diabetes
• Obesity
• Tasks requiring repetitive wrist flexion or forearm pronation

• Medial elbow pain which may vary from mild to severe
• When severe, pain may spread to involve the medial forearm
• Pain onset is typically insidious
• Pain that is aggravated by repetitive wrist and elbow movements (e.g., gripping and throwing)
• Pain that eases with rest
• When severe, pain may interfere with basic daily tasks and interrupt sleep
• May also present with symptoms of ulnar nerve compression

• Localized tenderness just distal and over to the medial epicondyle
• Pain aggravation with active wrist flexion and forearm pronation
• Pain aggravation with passive wrist extension
• Positive Golfer’s Elbow test (Reverse Cozen’s test)
• Positive Reverse Mill’s test

Medial elbow tendinopathy is usually a clinical diagnosis. Diagnostic imaging is usually unnecessary. However, diagnostic ultrasound can be used to demonstrate the extent of tendinopathy. Plain radiography may also be useful to help rule out bone and joint pathology. To assess for intra-articular and alternative soft tissue pathology, magnetic resonance imaging (MRI) can be used.

The following are examples of “red flags” for patients presenting with elbow pain:

• History of a significant injury
• Severe pain
• Unrelenting pain
• Nocturnal pain or pain at rest
• Fever
• Deformity
• Large joint swelling
• Significant loss of range of motion
• Significant neurological impairment
• Severe tenderness on palpation or severe pain with any examination procedure

If any “red flags” are identified during history taking and clinical examination, referral for urgent medical evaluation and further investigation is warranted.

Check for Possible Medial Collateral Ligament Sprain

Medial collateral ligament sprain may also present with pain similar to that of medial elbow tendinopathy. The Valgus Stress test is designed to detect the presence of medial collateral ligament involvement.