Medial Epicondylitis

(Golfer’s Elbow)

ByPaul L. Liebert, MD, Tomah Memorial Hospital, Tomah, WI
Reviewed/Revised Nov 2023
View Patient Education

Medial epicondylitis is inflammation of the flexor pronator muscle mass originating at the medial epicondyle of the elbow. Diagnosis is with provocative testing. Treatment is rest and ice and then exercises and gradual return to activity.

Medial epicondylitis is caused by any activity that places a valgus force on the elbow or that involves forcefully flexing the volar forearm muscles, as occurs during pitching, golfing with improper technique, serving a tennis ball (particularly with top spin, with a racket that is too heavy or too tightly strung or has an undersized grip, or with heavy balls), and throwing a javelin. Nonathletic activities that may cause medial epicondylitis include bricklaying, hammering, and typing.

Symptoms and Signs of Medial Epicondylitis

Pain occurs in the flexor pronator tendons (attached to the medial epicondyle) and in the medial epicondyle when the wrist is flexed or pronated against resistance.

Diagnosis of Medial Epicondylitis

  • Provocative testing

To confirm the diagnosis, the examiner has the patient sit in a chair with the forearm resting on a table and the hand supinated. The patient tries to raise the fist by bending the wrist while the examiner holds it down. Pain around the medial epicondyle and in the flexor tendon origin confirms the diagnosis. (See also How to Examine the Elbow.)

Treatment of Medial Epicondylitis

  • Rest, ice, and muscle stretches

  • Modification of activity

  • Later, resistive exercises

Treatment is symptomatic and similar to that of lateral epicondylitis. Patients should avoid any activity that causes pain. Initially, rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching are used, occasionally with a corticosteroid injection into the painful area around the tendon. When pain subsides, gentle resistive exercises of the extensor and flexor muscles of the forearm are done, followed by eccentric and concentric resistive exercises. In general, surgery is considered only after at least 9 to 12 months of failed conservative management. Surgical techniques to treat medial epicondylitis involve removing scar tissue and reattaching damaged tissues.

Exercises to Relieve Medial Epicondylitis
Resisted Finger Abduction and Extension With Putty
Resisted Finger Abduction and Extension With Putty
1. Flatten putty on table. 2. Flex (curl) fingers and place on putty. 3. Extend and abduct (spread) fingers. 4. Perform... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

Resisted Hand and Finger Gripping With Towel
Resisted Hand and Finger Gripping With Towel
1. Grasp and gently squeeze towel roll with both hands. 2. Twist towel in alternating directions. 3. Perform 3 sets of... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

Resisted Wrist Extension With Weight
Resisted Wrist Extension With Weight
1. Place forearm on table with the hand palm down, off the edge of the table. 2. Move wrist up into extension. 3. Slowl... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

Resisted Wrist Flexion With Weight
Resisted Wrist Flexion With Weight
1. Place forearm on table with the hand palm up, off the edge of the table. 2. Curl wrist up into flexion. 3. Slowly lo... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

Wrist Flexor Stretch
Wrist Flexor Stretch
1. Position involved hand palm up. 2. Grasp fingers on involved hand with the other hand. 3. Keep elbow straight on inv... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

Wrist Extensor Stretch
Wrist Extensor Stretch
1. Begin with the elbow straight. 2. With the uninvolved hand, grasp thumb side of hand and bend wrist downward into wr... read more

Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.

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