Treatment of Medial Epicondyle Injury
The treatment of medial epicondyle injury should begin with conservative management including rest, ice application, NSAIDs, and activity modification for 6-12 weeks, with surgical intervention reserved for cases that fail to respond after 6 months of appropriate non-operative care.
Diagnosis
Before initiating treatment, proper diagnosis is essential:
- Radiography is the appropriate initial imaging modality for acute elbow pain to rule out fractures 1
- Ultrasound can be useful for evaluating soft tissue injuries, with high sensitivity for detecting medial epicondylalgia 1
- MRI should be considered for persistent symptoms to evaluate associated tendon pathology 2
Treatment Algorithm
1. Conservative Management (0-6 weeks)
- Rest and activity modification
- Ice application for 10-minute periods through a wet towel
- NSAIDs for pain and inflammation control
- Protective padding or elbow sleeve to prevent recurrence
- Begin eccentric strengthening exercises 2
2. Intermediate Management (6-12 weeks)
- Continue activity modification and exercises
- Consider corticosteroid injection (limit to 1-2 injections)
- Progress eccentric strengthening exercises 2
- Manual therapy combined with exercise therapy may be beneficial
3. Persistent Symptoms (>3 months)
- Reassessment with imaging
- Continue rehabilitation program
- Consider referral to orthopedic specialist if symptoms persist
4. Surgical Management (after 6+ months of failed conservative treatment)
- Indicated for debilitating pain that persists despite well-managed non-operative treatment for at least 6 months 3, 4
- Surgical technique involves:
- Excision of the pathologic portion of the tendon
- Repair of the resulting defect
- Reattachment of the origin of the flexor pronator muscle group to the medial epicondyle 3
Special Considerations for Medial Epicondyle Fractures
For medial epicondyle fractures, particularly in pediatric patients:
- Closed reduction and percutaneous Kirschner wire pinning is the preferred treatment for most displaced fractures 1
- The American Academy of Orthopaedic Surgeons suggests closed reduction with pin fixation for displaced pediatric supracondylar fractures 1
- In the pediatric overhead athlete, assessment of anterior displacement is important as it may affect elbow stability and range of motion 5
- Advanced imaging such as CT or MRI may be needed to adequately assess anterior displacement in these cases 5
Prevention of Recurrence
- Use elbow pads during activities that put pressure on the elbow
- Avoid leaning on elbows for prolonged periods
- Maintain proper ergonomics at workstations
- Implement technique modifications for athletes and manual laborers to minimize repetitive stress
- Develop a strength and flexibility program focusing on forearm muscles 2
Common Pitfalls and Caveats
Misdiagnosis: Medial epicondylitis is often misdiagnosed as inflammation when it's actually angiofibroblastic degeneration (tendinosis) 6
Overtreatment with steroids: Corticosteroid injections provide short-term pain relief but have not demonstrated long-term benefit and should be limited to 1-2 injections 6, 2
Premature surgery: Surgical intervention should only be considered after at least 6 months of appropriate conservative management 3, 4
Inadequate rehabilitation: Eccentric strengthening exercises should be continued for at least 12 weeks for optimal outcomes 2
Overlooking associated pathologies: Medial epicondylitis may coexist with other elbow pathologies that require different treatment approaches 7