Epicondylitis of the humerus

Medial epicondylitis, or "golfer's elbow" was first described in 1882 by Henry J. Morris, and is currently one of the main causes of pain in the inner parts of the elbow and forearm. This condition can be considered as a syndrome of overloading of the flexor muscles and pronators of the hand, mainly the radial flexor of the hand and the circular pronator, which attach to the medial epicondyle of the humerus. In more than 50 percent of cases, the ulnar nerve is involved in the process.

The development of medial epicondylitis is associated with sports activities that require frequent or prolonged flexion and pronation of the forearm and hand, such as golf, baseball, swimming, fencing, arm wrestling, and others. As a result, angiofibroplastic changes in collagen and inflammatory changes are formed, leading to microfractures of muscles and their tendons, and degenerative changes in the epicondyle of the humerus. The elbow joint of the dominant arm is more often involved in men aged 30 to 50 years.

The main complaint is pain or discomfort in the projection of the medial epicondyle of the shoulder, usually during movements, as well as weakness and radiating pain in the forearm and hand. Examination reveals soreness on palpation along the anterior surface of the medial epicondyle of the shoulder, in the projection of the muscles involved. A local diagnostic injection of a local anesthetic completely stops the pain. The amount of movement in the elbow joint remains normal. It is important to distinguish medial epicondylitis from isolated ulnar nerve neuropathy and radiculopathy, which is facilitated by a detailed neurological examination.  

The treatment is based on conservative therapy and modification of physical activity. For prevention and during treatment, proper playing technique is necessary, and, consequently, classes are supervised by a competent coach. A brace is shown to relieve the involved muscles. In the acute period, cold, nonsteroidal anti-inflammatory drugs are applied topically, followed by physiotherapy, physical therapy aimed at stretching and strengthening the muscles of the forearm. Local injection of corticosteroids may be useful to reduce pain and inflammation.If conservative treatment is ineffective for 6-12 months, surgical intervention is advisable: tendon release, debridement of damaged tissues, tunneling of the medial epicondyle to improve blood supply, revision of the ulnar nerve in case of its involvement in the process, tendon refixation. In most cases, the intervention can be performed from arthroscopic approaches.