Management of Medial Epicondyle Tendonitis
The management of medial epicondyle tendonitis should follow a stepwise approach beginning with conservative measures for 3-6 months before considering more invasive interventions, as most patients (approximately 80%) will fully recover within this timeframe with appropriate treatment. 1
First-Line Conservative Management
Relative Rest: Allow patients to continue activities that do not worsen pain while avoiding those that exacerbate symptoms. Complete immobilization should be avoided to prevent muscular atrophy and deconditioning. 1
Ice Therapy: Apply ice through a wet towel for 10-minute periods to provide short-term pain relief, reduce swelling, and blunt inflammatory response in acute cases. 1
Analgesics: NSAIDs effectively relieve tendinopathy pain and may offer additional benefit in acute inflammatory tendonitis. Topical NSAIDs are preferable as they eliminate the increased risk of gastrointestinal hemorrhage associated with systemic NSAIDs. 1
Eccentric Strengthening Exercises: These stimulate collagen production and guide normal alignment of newly formed collagen fibers. While proven beneficial in Achilles and patellar tendinosis, they may also help in medial epicondyle tendonitis. 1, 2
Stretching Exercises: Generally thought to be helpful and widely accepted for tendon rehabilitation, though specific evidence for medial epicondyle tendonitis is limited. 1, 2
Second-Line Interventions
Braces/Orthotics: Tennis elbow bands can help reinforce, unload, and protect tendons during activity. Although few data support definitive conclusions regarding their effectiveness, they are safe and often helpful in correcting biomechanical problems. 1, 2
Corticosteroid Injections: May be more effective than oral NSAIDs for relief in the acute phase but do not alter long-term outcomes. Should be used with caution as they may inhibit healing and reduce tensile strength of the tissue, potentially predisposing to rupture. 1
Therapeutic Ultrasonography: May decrease pain and increase the rate of collagen synthesis, but evidence for consistent benefit is weak. 1, 2
Extracorporeal Shock Wave Therapy (ESWT): Appears to be a safe, noninvasive option for pain relief, though further research is needed to establish its efficacy specifically for medial epicondyle tendonitis. 1, 2
Imaging Considerations
Plain radiography may show osteophyte formation at the epicondyles, degenerative joint disease, loose bodies, or fractures, but is often normal in isolated tendinopathy. 1
Ultrasonography can demonstrate tendon thickening and heterogeneous echogenicity, which are common findings in elbow tendinopathy. 1
MRI is useful for showing degenerative thickening of the tendons, fibrovascular proliferation, and mucoid degeneration when the diagnosis remains unclear after thorough history and physical examination. 1
Surgical Management
Surgical evaluation is warranted if pain persists despite 3-6 months of well-managed conservative treatment. 1, 2
Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis. 2, 3
Surgical success rates range from 63% to 100%, with a low complication rate of 4.3%. 3
Return to sports rates range from 81% to 100%, and return to work rates are generally above 90%. 3, 4
Important Clinical Considerations
Medial epicondylitis (golfer's elbow) is less common than lateral epicondylitis (tennis elbow), which is 7-10 times more prevalent. 2, 5
Activities requiring repetitive wrist flexion and forearm pronation contribute to the development of medial epicondylitis. 2, 5
The condition predominates in amateur rather than professional athletes and is more common in patients over 40 years of age. 5
When surgical treatment is performed, care must be taken to avoid damage to the medial collateral ligament (MCL), which begins approximately 10.4 mm from the posterior ridge of the medial epicondyle. 6
Technique modification for athletes and manual laborers aims to minimize repetitive stresses placed on tendons and should be incorporated into the treatment plan. 2