Lateral and Medial Epicondylitis

Question 1

Medial vs Lateral

(1) _______ tendinosis: Tennis Elbow
(2) _______ tendinosis: Golfer’s elbow, bowler’s elbow

Answer 1

1. Lateral

2. Medial

Question 2

_________ is an overuse injury involving excessive use of the flexor and pronator muscles just distal to the medial epicondyle

• Activities that require excessive wrist and hand flexion lead to this
• Less common than lateral tendinosis

Answer 2

Medial epicondylitis

Question 3

What issue?
Gradual onset of pain in lateral elbow and forearm during
activities involving gripping and wrist extension
IE
Lifting, Turning screwdriver, Hitting backhand in tennis, Excessive typing. Less common, results from direct blow to lateral aspect of elbow
-Physical Exam
(1) Visual = Typically unremarkable
(2) Palpation
–1) Tenderness over common extensor origin
–2) 1cm distal and slightly anterior to lateral epicondyle
(3) ROM = Full AROM
(4) Muscle test = Wrist extension and grip strength limited by pain
(5) Neurovascular = Typically unremarkable
(6) Special test = Pain in lateral epicondyle with resisted extension of the wrist

Answer 3

Lateral epicondylitis
Treatment
(a) Light duty/duty modifications
–1) Limit repetitive activity to allow for healing
(b) NSAIDS
(c) Tennis elbow strap for comfort
(d) Pain free stretching and forearm strengthening
(e) Consult to physical therapy if conservative management fails
(f) Ortho consult if no improvement
(g) Steroid injection

Question 4

What issue / Tx?
Gradual onset of pain at medial aspect of elbow. Exacerbated by activities that involve wrist flexion and forearm pronation.
IE
(a) Golf swing, Baseball pitching, Pull-through stroke of swimming, Weight-lifting, Bowling, Many forms of manual.
Physical Exam
(1) Visual
-(a) Typically unremarkable
(2) Palpation
-1) Tenderness just distal to medial epicondyle
(3) ROM
-1) Full AROM
(4) Muscle test
-1) Wrist flexion and pronation limited by pain
(5) Neurovascular
-(a) Typically unremarkable
(6) Special test
-(b) Pain in medial epicondyle with resisted flexion of the wrist

Answer 4

Medial Epicondylitis

Treatment

(a) Light duty/duty modifications
- -1) Limit repetitive activity to allow for healing
(b) NSAIDS
(c) Tennis elbow strap for comfort
(d) Pain free stretching and forearm strengthening
(e) Consult to physical therapy if conservative management fails
(f) Ortho consult if no improvement
(g) Steroid injection

Question 5

Diagnostic tests

(a) Diagnosed ______
- -1) History and physical exam enough for diagnosis
(b) Plain radiographs _____ needed in patients with elbow pain and no history of trauma
(c) Ultrasound/MRI in cases not responding to ________

Answer 5

a) Clinically
b) rarely
c) conservative management

Question 6

Referral Decision and Red Flags Epicondylitis

Failure of conservative management indicates need for ______

Answer 6

further evaluation