Medial Epicondylalgia

Medial epicondylalgia (golfer's elbow) is a tendinopathy of the common flexor-pronator origin at the medial epicondyle, most often involving pronator teres and flexor carpi radialis.

It is less common than lateral epicondylalgia: a Finnish population study found a prevalence of 0.4%, against 1.3% for the lateral side, highest at age 45 to 54 and equal in men and women. Despite the name, it is more often caused by repetitive gripping, wrist flexion and pronation at work than by golf.

Most cases settle with non-surgical care. The ulnar nerve lies just behind the medial epicondyle and is often involved.

The common flexor-pronator origin carries pronator teres, flexor carpi radialis (FCR), palmaris longus, flexor digitorum superficialis and flexor carpi ulnaris. Pronator teres and FCR are most often affected. As on the lateral side, the pathology is failed healing rather than inflammation: disorganised collagen, neovascularisation and increased ground substance.

Neighbouring structures matter clinically:

• •The ulnar nerve runs in the cubital tunnel immediately behind the medial epicondyle. It may be irritated alongside the tendinopathy, and it is at risk from any injection
• •The medial (ulnar) collateral ligament lies deep to the flexor origin; its anterior bundle is the main restraint to valgus stress and is the classic injury in throwing athletes

The Cook and Purdam continuum (reactive, dysrepair, degenerative) guides loading. Risk factors include repetitive wrist flexion and pronation, forceful work, throwing and racquet sports, smoking and obesity.