Medial Epicondylalgia

Question 1

Pathophysiology

Answer 1

• microtearing common flex tendon at medial epicondyle of humerus
• affects flexors and pronators usually FCR and Pronator teres

Question 2

Aggrevating factors

Answer 2

• tasks of repeated loading gripping and wrist flex as well as resisted forearm pronation
• supination and valgus forces at the medial elbow during activities such as throwing, golf and tennis

Question 3

Prevalence

Answer 3

40-60 yrs

• sport: golfers, tennis players (top spin), baseball, javelin, weightlifting, archery
• occupation: repeated forceful wrist movement, vibrating too use

Question 4

MOI

Answer 4

• Insidious onset: often associated with increase activity or new activity
• or acute onset of pain associated with single instance of wrist flexor/ forearm pronator exertion
• increased repetitive loading from activities involving repeated wrist flexion
• traumatic: medial blow to elbow

Question 5

Complaints

Answer 5

• Localised pain around the medial epicondyle after unaccustomed/increase in activity
• sharp, stabbing, burning pain around medial epicondyle
• exacerbated by wrist flex and forearm pronation in work, sport or ADL
• pain eased by ice

Question 6

Physical exam:

Obs

Answer 6

no obvious

Question 7

Physical exam: palpation

Answer 7

-tenderness 5-10 mm anterior and distal to medial epicondyle

Question 8

Physical exam: movement examination

Answer 8

• Pain/weakness with MMT for wrist flexors and pronator theres in elbow ext
• moving forearm into flex against a load= pain
• pain and weakness with GRIPPING
• pain when stretching into ext
• pain combined wrist and finger ext

Question 9

Physical exam: positive tests

Answer 9

-pain on resisted wrist flex, finger flex, pronation

Question 10

Management

Answer 10

Same as for lateral epicondylalgia

Question 11

Surgical Rx

Answer 11

Recommended at 3-6 mths no response conservative treatment