Symptoms of Medial Epicondylitis
Medial epicondylitis presents with pain localized to the medial epicondyle that worsens with resisted wrist flexion and forearm pronation, affecting primarily laborers and throwing athletes who perform repetitive wrist flexion activities. 1, 2
Clinical Presentation
Pain at the medial epicondyle is the hallmark symptom, typically developing from repetitive wrist flexion and forearm pronation activities 1, 2
Pain with resisted wrist flexion and forearm pronation distinguishes this from other elbow pathologies 3
Occupational or athletic activities are the typical triggers, with 90% of cases work-related and only 10% sport-related, though throwing athletes are particularly susceptible 1, 4
Dominant arm involvement is typical, affecting patients with a mean age around 42-48 years 5, 3
Critical Diagnostic Consideration
Coexistent ulnar neuritis occurs in approximately 60% of cases and must be identified, as it significantly affects treatment outcomes and prognosis 3
Patients with isolated medial epicondylitis have substantially better outcomes than those with concurrent ulnar neuritis (69% symptom-free versus only 13% symptom-free after treatment) 3
Night pain, pain at rest, or mechanical symptoms (locking, catching) suggest alternative diagnoses requiring further workup 6
Physical Examination Findings
Tenderness directly over the medial epicondyle at the common flexor-pronator origin 1, 5
Pain with resisted palmar flexion of the hand and wrist is a key diagnostic maneuver 3
Decreased grip strength compared to the uninvolved arm, often measuring around 54% of normal strength in affected patients 5
Neurologic examination is essential to identify concurrent ulnar nerve involvement, which dramatically changes the treatment approach and expected outcomes 3
Common Pitfall to Avoid
The most critical error is failing to distinguish medial epicondylitis from coexistent ulnar neuritis, as the latter requires additional intervention (cubital tunnel release) and has a significantly worse prognosis even with appropriate surgical treatment 3. Always perform a thorough neurologic examination of the ulnar nerve distribution.