How is medial epicondylitis treated?

Treatment of Medial Epicondylitis

Most patients with medial epicondylitis should be treated with conservative measures including relative rest, icing, and eccentric strengthening exercises, as approximately 80% of patients fully recover within three to six months with this approach. 1

Understanding Medial Epicondylitis

Medial epicondylitis, also known as "golfer's elbow," is a degenerative condition (tendinopathy) rather than an inflammatory process, affecting the common flexor tendon at its insertion on the medial epicondyle. It is less common than lateral epicondylitis (tennis elbow), occurring 7-10 times less frequently 2.

Diagnostic Approach

• Point tenderness over the medial epicondyle
• Pain with resisted wrist flexion and forearm pronation
• Imaging only needed if diagnosis is unclear:
  • Ultrasound: Can visualize tendinous structures but has limited evidence in acute settings 1
  • MRI: May be used when diagnosis remains uncertain 1

Treatment Algorithm

First-Line Treatment (0-3 months)

1. Relative rest: Avoid aggravating activities
2. Ice application: 15-20 minutes several times daily
3. Eccentric strengthening exercises: Focus on wrist flexors
4. Pain management:
   • Analgesics for pain control
   • Topical and systemic NSAIDs may provide short-term relief but are not recommended over other analgesics 1

Second-Line Treatment (if symptoms persist)

1. Corticosteroid injections: Can provide pain relief but should be used with caution due to potential side effects 1
2. Counterforce bracing: May help reduce strain on the affected tendon 3
3. Technique modification: For sports or occupational activities 2

Third-Line Treatment (after 6+ months of failed conservative therapy)

1. Surgical intervention: Involves excision of pathologic portion of tendon, repair of the defect, and reattachment of the origin to the medial epicondyle 3
   • High degree of subjective relief reported
   • Reserved for patients with debilitating pain that persists despite well-managed conservative treatment for at least 6 months

Important Clinical Considerations

• Misdiagnosis risk: Medial epicondylitis is often misdiagnosed as "tendonitis" when it is actually a degenerative condition (tendinopathy) 1
• Recovery timeline: About 80% of patients recover fully within 3-6 months with conservative treatment 1
• Surgical outcomes: Only approximately 5% of patients will ultimately require surgical intervention 4
• Differential diagnosis: Important to distinguish from other medial elbow pathologies that may coexist 5

Prevention Strategies

• Strengthen forearm muscles
• Modify techniques in sports and occupational activities
• Ensure proper equipment (for sports-related cases)
• Gradual return to activities following recovery

The evidence strongly supports starting with conservative measures, as they are effective for the vast majority of patients, with surgery reserved only for those with persistent symptoms despite adequate conservative management.