Medial Epicondylitis: A Systematic Review on Causes, Symptoms and Treatment
DOI:
https://doi.org/10.12775/QS.2024.36.56572Keywords
elbow tendinopathy, athletes, sports, rehabilitation, cumulative trauma disordersAbstract
Introduction: Medial epicondylitis, often called golfer's elbow, involves pain on the inner side of the elbow. It usually results from repetitive strain on the tendons that connect the forearm muscles to the medial epicondyle. While commonly linked to golfing, it can affect people engaged in various activities requiring repetitive wrist flexion and gripping.
Purpose of work: This paper aims to provide a comprehensive overview of the pathogenesis, imaging characteristics, and treatment strategies for medial epicondylitis.
State of knowledge: Medial epicondylitis can be worsened by activities that require forceful gripping, such as golfing or weightlifting [1][2]. The condition has been extensively studied and is well-documented in the scientific literature. Various treatments are available, including conservative methods like rest, physical therapy, and injections, as well as surgical interventions for persistent cases.
Material and methods: This review draws upon an in-depth analysis of current scientific literature, including recent publications in prominent medical journals and relevant research studies. To identify pertinent scientific publications and research studies, comprehensive searches were conducted on widely recognized academic databases, such as PubMed and Google Scholar.
Summary: Medial epicondylitis, also known as "golfer's elbow," is characterized by pain and tenderness over the bony prominence on the inner side of the elbow. It often results from repetitive strain or overuse of the muscles that flex the wrist and pronate the forearm [3]. Diagnostic imaging, such as X-rays and MRI, can help evaluate this condition [1][4]. Treatment typically involves a combination of conservative approaches, including rest, physical therapy, and anti-inflammatory medications, as well as more invasive options like corticosteroid injections or surgery for persistent cases.
References
Schnatz, P. F., & Steiner, C. (1993). Tennis elbow: a biomechanical and therapeutic approach. In P. F. Schnatz & C. Steiner, PubMed (Vol. 93, Issue 7, p. 778). National Institutes of Health. https://pubmed.ncbi.nlm.nih.gov/8365926
McCluskey, G. M., & Merkley, M. S. (2002). Lateral and Medial Epicondylitis. In G. M. McCluskey & M. S. Merkley, Springer eBooks (p. 79). Springer Nature. https://doi.org/10.1007/0-387-21533-6_6
Walz, D. M., Newman, J. S., Konin, G. P., & Ross, G. (2010). Epicondylitis: Pathogenesis, Imaging, and Treatment. In D. M. Walz, J. S. Newman, G. P. Konin, & G. Ross, Radiographics (Vol. 30, Issue 1, p. 167). Radiological Society of North America. https://doi.org/10.1148/rg.301095078
Geoffroy, P. A., Yaffe⃰, M. J., & Rohan, I. (1994). Diagnosing and treating lateral epicondylitis. In P. A. Geoffroy, M. J. Yaffe⃰, & I. Rohan, PubMed (Vol. 40, p. 73). National Institutes of Health. https://pubmed.ncbi.nlm.nih.gov/8312757
Malone, A. A., Larson, S. G., Morrey, B. F., Llusá-Pérez, M., Ballesteros-Betancourt, J. R., An, K., Morrey, M. E., Rhodes, N. G., Wessell, D. E., Garner, H. W., Bestie, J., Moynagh, M. R., Surgical, E., Morrey, M. E., Uusä-Pärez, M., Liusa-Perez, M., Sánchez‐Sotelo, J., Kopp, S. L., Horlocker, T. T., … Morrey, M. E. (2018). Morrey’s the Elbow and its Disorders. In A. A. Malone, S. G. Larson, B. F. Morrey, M. Llusá-Pérez, J. R. Ballesteros-Betancourt, K. An, M. E. Morrey, N. G. Rhodes, D. E. Wessell, H. W. Garner, J. Bestie, M. R. Moynagh, E. Surgical, M. E. Morrey, M. Uusä-Pärez, M. Liusa-Perez, J. Sánchez‐Sotelo, S. L. Kopp, T. T. Horlocker, … M. E. Morrey, Elsevier eBooks. Elsevier BV. https://doi.org/10.1016/c2011-0-06694-2
Amin, N. H., Kumar, N. S., & Schickendantz, M. S. (2015). Medial Epicondylitis. In N. H. Amin, N. S. Kumar, & M. S. Schickendantz, Journal of the American Academy of Orthopaedic Surgeons (Vol. 23, Issue 6, p. 348). https://doi.org/10.5435/jaaos-d-14-00145
Hopkins, C., Fu, S., Chua, E. N., Hu, X., Rolf, C., Mattila, V. M., Qin, L., Yung, P. S., & Chan, K. (2016). Critical review on the socio-economic impact of tendinopathy. In C. Hopkins, S. Fu, E. N. Chua, X. Hu, C. Rolf, V. M. Mattila, L. Qin, P. S. Yung, & K. Chan, Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology (Vol. 4, p. 9). Elsevier BV. https://doi.org/10.1016/j.asmart.2016.01.002
Raval, P., Gibbs, V. N., Shepherd, J., & Pandey, R. (2024). Common tendinopathies around the elbow. In P. Raval, V. N. Gibbs, J. Shepherd, & R. Pandey, Orthopaedics and Trauma (Vol. 38, Issue 4, p. 182). Elsevier BV. https://doi.org/10.1016/j.mporth.2024.05.001
Hassebrock, J. D., Patel, K. A., Makovicka, J. L., Chung, A. S., Tummala, S. V., Hydrick, T. C., Ginn, J., Hartigan, D. E., & Chhabra, A. (2019). Elbow Injuries in National Collegiate Athletic Association Athletes: A 5-Season Epidemiological Study. In J. D. Hassebrock, K. A. Patel, J. L. Makovicka, A. S. Chung, S. V. Tummala, T. C. Hydrick, J. Ginn, D. E. Hartigan, & A. Chhabra, Orthopaedic Journal of Sports Medicine (Vol. 7, Issue 8, p. 232596711986195). SAGE Publishing. https://doi.org/10.1177/2325967119861959
Degen, R. M., Conti, M. S., Camp, C. L., Altchek, D. W., Dines, J. S., & Werner, B. C. (2017). Epidemiology and Disease Burden of Lateral Epicondylitis in the USA: Analysis of 85, 318 Patients. In R. M. Degen, M. S. Conti, C. L. Camp, D. W. Altchek, J. S. Dines, & B. C. Werner, HSS Journal® The Musculoskeletal Journal of Hospital for Special Surgery (Vol. 14, Issue 1, p. 9). SAGE Publishing. https://doi.org/10.1007/s11420-017-9559-3
Cook, J., Rio, E., Purdam, C., & Docking, S. (2016). Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? In J. Cook, E. Rio, C. Purdam, & S. Docking, British Journal of Sports Medicine (Vol. 50, Issue 19, p. 1187). BMJ. https://doi.org/10.1136/bjsports-2015-095422
Zwerus, E. L., Somford, M. P., Maissan, F., Heisen, J., Eygendaal, D., & Bekerom, M. P. van den. (2017). Physical examination of the elbow, what is the evidence? A systematic literature review. In E. L. Zwerus, M. P. Somford, F. Maissan, J. Heisen, D. Eygendaal, & M. P. van den Bekerom, British Journal of Sports Medicine (Vol. 52, Issue 19, p. 1253). BMJ. https://doi.org/10.1136/bjsports-2016-096712
Bhabra, G., Wang, A., Ebert, J. R., Edwards, P., Zheng, M., & Zheng, M. (2016). Lateral Elbow Tendinopathy. In G. Bhabra, A. Wang, J. R. Ebert, P. Edwards, M. Zheng, & M. Zheng, Orthopaedic Journal of Sports Medicine (Vol. 4, Issue 11, p. 232596711667063). SAGE Publishing. https://doi.org/10.1177/2325967116670635
Wolfson, T. S., Maheshwer, B., Polce, E. M., Ahmad, C. S., & Verma, N. N. (2024). Golfer’s Elbow (Medial Epicondylitis). In T. S. Wolfson, B. Maheshwer, E. M. Polce, C. S. Ahmad, & N. N. Verma, CRC Press eBooks (p. 145). Informa. https://doi.org/10.1201/9781003526568-12
Beyer, R., Kongsgaard, M., Kjær, B. H., Øhlenschlæger, T. F., Kjær, M., & Magnusson, S. P. (2015). Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy. In R. Beyer, M. Kongsgaard, B. H. Kjær, T. F. Øhlenschlæger, M. Kjær, & S. P. Magnusson, The American Journal of Sports Medicine (Vol. 43, Issue 7, p. 1704). SAGE Publishing. https://doi.org/10.1177/0363546515584760
Heinemeier, K. M., Øhlenschlæger, T. F., Mikkelsen, U. R., Sønder, F., Schjerling, P., Svensson, R. B., & Kjær, M. (2017). Effects of anti-inflammatory (NSAID) treatment on human tendinopathic tissue. In K. M. Heinemeier, T. F. Øhlenschlæger, U. R. Mikkelsen, F. Sønder, P. Schjerling, R. B. Svensson, & M. Kjær, Journal of Applied Physiology (Vol. 123, Issue 5, p. 1397). American Physiological Society. https://doi.org/10.1152/japplphysiol.00281.2017
Abate, M., Salini, V., Schiavone, C., & Andı́a, I. (2016). Clinical benefits and drawbacks of local corticosteroids injections in tendinopathies. In M. Abate, V. Salini, C. Schiavone, & I. Andı́a, Expert Opinion on Drug Safety (Vol. 16, Issue 3, p. 341). Taylor & Francis. https://doi.org/10.1080/14740338.2017.1276561
Fitzpatrick, J., Bulsara, M., & Zheng, M. (2016). The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials. In J. Fitzpatrick, M. Bulsara, & M. Zheng, The American Journal of Sports Medicine (Vol. 45, Issue 1, p. 226). SAGE Publishing. https://doi.org/10.1177/0363546516643716
Auersperg, V., & Trieb, K. (2020). Extracorporeal shock wave therapy: an update. In V. Auersperg & K. Trieb, EFORT Open Reviews (Vol. 5, Issue 10, p. 584). British Editorial Society of Bone & Joint Surgery. https://doi.org/10.1302/2058-5241.5.190067
Schwartz, M. A., Ciccotti, M. C., & Ciccotti, M. G. (2006). Open Treatment of Medial Epicondylitis. In M. A. Schwartz, M. C. Ciccotti, & M. G. Ciccotti, Techniques in Orthopaedics (Vol. 21, Issue 4, p. 283). Lippincott Williams & Wilkins. https://doi.org/10.1097/01.bto.0000252146.11900.b2
Grawe, B. M., Fabricant, P. D., Chin, C., Allen, A. A., DePalma, B. J., Dines, D. M., Altchek, D. W., & Dines, J. S. (2016). Clinical Outcomes After Suture Anchor Repair of Recalcitrant Medial Epicondylitis. In B. M. Grawe, P. D. Fabricant, C. Chin, A. A. Allen, B. J. DePalma, D. M. Dines, D. W. Altchek, & J. S. Dines, Orthopedics (Vol. 39, Issue 1). Slack Incorporated (United States). https://doi.org/10.3928/01477447-20151222-09
DeLuca, M. K., Cage, E., Stokey, P. J., & Ebraheim, N. A. (2023). Medial epicondylitis: Current diagnosis and treatment options. In M. K. DeLuca, E. Cage, P. J. Stokey, & N. A. Ebraheim, Journal of Orthopaedic Reports (Vol. 2, Issue 3, p. 100172). Elsevier BV. https://doi.org/10.1016/j.jorep.2023.100172
Biz, C., Crimì, A., Belluzzi, E., Maschio, N., Baracco, R., Volpin, A., & Ruggieri, P. (2019). Conservative Versus Surgical Management of Elbow Medial Ulnar Collateral Ligament Injury: A Systematic Review. In C. Biz, A. Crimì, E. Belluzzi, N. Maschio, R. Baracco, A. Volpin, & P. Ruggieri, Orthopaedic Surgery (Vol. 11, Issue 6, p. 974). Wiley. https://doi.org/10.1111/os.12571
Tarpada, S. P., Morris, M., Lian, J., & Rashidi, S. (2018). Current advances in the treatment of medial and lateral epicondylitis. In S. P. Tarpada, M. Morris, J. Lian, & S. Rashidi, Journal of Orthopaedics (Vol. 15, Issue 1, p. 107). Elsevier BV. https://doi.org/10.1016/j.jor.2018.01.040
Niemiec, P., Szyluk, K., Jarosz, A., Iwanicki, T., & Balcerzyk, A. (2022). Effectiveness of Platelet-Rich Plasma for Lateral Epicondylitis: A Systematic Review and Meta-analysis Based on Achievement of Minimal Clinically Important Difference. In P. Niemiec, K. Szyluk, A. Jarosz, T. Iwanicki, & A. Balcerzyk, Orthopaedic Journal of Sports Medicine (Vol. 10, Issue 4, p. 232596712210869). SAGE Publishing. https://doi.org/10.1177/23259671221086920
Arevalo, A., Rao, S., Willier, D. P., Schrock, C. I., Erickson, B. J., Jack, R. A., Cohen, S. B., & Ciccotti, M. G. (2022). Surgical Techniques and Clinical Outcomes for Medial Epicondylitis: A Systematic Review. In A. Arevalo, S. Rao, D. P. Willier, C. I. Schrock, B. J. Erickson, R. A. Jack, S. B. Cohen, & M. G. Ciccotti, The American Journal of Sports Medicine (Vol. 51, Issue 9, p. 2506). SAGE Publishing. https://doi.org/10.1177/03635465221095565
Korcari, A., Przybelski, S. J., Gingery, A., & Loiselle, A. E. (2022). Impact of aging on tendon homeostasis, tendinopathy development, and impaired healing. In A. Korcari, S. J. Przybelski, A. Gingery, & A. E. Loiselle, Connective Tissue Research (Vol. 64, Issue 1, p. 1). Taylor & Francis. https://doi.org/10.1080/03008207.2022.2102004
Odebiyi, D. O., & Okafor, U. (2023). Musculoskeletal Disorders, Workplace Ergonomics and Injury Prevention. In D. O. Odebiyi & U. Okafor, IntechOpen eBooks. IntechOpen. https://doi.org/10.5772/intechopen.106031
Frizziero, A., Vittadini, F., Fusco, A., Giombini, A., & Masiero, S. (2016). Efficacy of eccentric exercise in lower limb tendinopathies in athletes. In A. Frizziero, F. Vittadini, A. Fusco, A. Giombini, & S. Masiero, PubMed (Vol. 56, Issue 11, p. 1352). National Institutes of Health. https://pubmed.ncbi.nlm.nih.gov/26609968
Augustin, G., Jeong, J. H., Kim, M., Hur, S. S., Lee, J.-H., & Hwang, Y. (2024). Stem Cell‐Based Therapies and Tissue Engineering Innovations for Tendinopathy: A Comprehensive Review of Current Strategies and Future Directions. In G. Augustin, J. H. Jeong, M. Kim, S. S. Hur, J.-H. Lee, & Y. Hwang, Advanced Therapeutics (Vol. 7, Issue 6). Wiley. https://doi.org/10.1002/adtp.202300425
Chen, X., Jones, I. A., Park, C., & Vangsness, C. T. (2017). The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. In X. Chen, I. A. Jones, C. Park, & C. T. Vangsness, The American Journal of Sports Medicine (Vol. 46, Issue 8, p. 2020). SAGE Publishing. https://doi.org/10.1177/0363546517743746
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Alicja Grzelak
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 377
Number of citations: 0
