Medial Epicondylitis (Golfer’s Elbow): Pathogenesis and clinical findings
Intrinsic Factors: age, body weight, nutrition, gender, anatomical variations, joint laxity, systemic disease, muscle weakness / imbalance, vascular perfusion
Micro-tears within flexor-pronator tendons initiating healing process: inflammation, proliferation, and remodeling (see acute wound healing slide)
Continued repetitive strains with inadequate recovery time between activitiesàhealing unable to meet tissue damage
Authors: Brett Lavender Reviewers: Alyssa Federico, Liam Thompson, Tara Shannon, *Gerhard Nikolaus Kiefer * MD at time of publication
Extrinsic Factors: activities involving repeated forceful use of the flexor-pronator muscle groups (sports including golf and baseball, activities such as shoveling, gardening or hammering nails)
Ineffective revascularization of damaged tissue
MRI or Ultrasound Findings: Tendon thickening, partial tears, disrupted vascular distribution +/- edema of surrounding tissues
Disorganized collagen formation and scarring à↑ type III collagen (most common collagen involved with wound healing)
↑ Tendon thickening
Decreased tensile strength of tendon
Weakness
of the flexor-pronator muscle groups
↑ Nerve growth within damaged tissue (consequence of healing response)
Local nerves are compressed by thickened tendonànociceptors within tendon are activated
(Ulnar nerve passes through cubital tunnel adjacent to medial epicondyle)
Ulnar paresthesias
may result to structures innervated distal to the cubital tunnel
Medial Epicondylitis
Tendinosis at the common flexor-pronator origin at the medial epicondyle of the humerus
Pain with passive wrist extension or resisted flexion
Tenderness
over the proximal wrist flexor-pronator muscles
Pain
localized to medial epicondyle
Severity ranges from mild to severe based on the effect on patient activities
Mild tendinopathy: patient continues most activities with minor pain
Moderate tendinopathy: patient continues some activities with modifications
Severe tendinopathy: patient’s daily activities are impacted by severe pain
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published August 30, 2022 on www.thecalgaryguide.com