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| Medial epicondylitis would appear to be far less common than lateral epicondylitis. Only one studty has directly compared the prevalence in a capitated general practice population, and found a ratio of 6:1 in favour of lateral epicondylitis 1. There are no extant studies devoted to the specific features. In particular, its natural history is not known.
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| | Assess for localised tenderness over the medial epicondyle with the elbow flexed at 90°, and for pain on resisted pronation of the forearm. Ulnar neuropathy may occur in severe cases. |
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| Such mention as in made of medial epicondylitis is typically in the context of lateral epicondylitis 2,3. It would appear that the literature generally assumes equivalence between the conditions so that even treatment series fail to discriminate between the two conditions. This does not seem entirely unreasonable, but begs the question as to whether treatment guidelines should be the same. Based on the implied consensus in the literature, in which the two conditions are lumped together, a cogent argument could be made that the same treatment considerations should apply in the absence of better evidence.
| | ==See Also== |
| | [[Lateral Elbow Tendinopathy]] |
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| ==DIAGNOSIS==
| | [[Category:Elbow and Forearm Conditions]] |
| | | [[Category:Tendinopathies]] |
| The diagnosis of medial epicondylitis is completely clinical, and relies upon the demonstration of pain and tenderness over the medial humeral epicondyle. Pain is said to be made worse by resisted wrist flexion. As for lateral epicondylitis, there are no data on the reliability of these signs. No investigation or imaging modalities have been formally assessed for their contribution to the diagnosis of medial epicondylitis.
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| ==TREATMENT==
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| Class I evidence
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| There are no systematic reviews for the treatment of medial epicondylitis.
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| Class II evidence
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| A randomised, double blind controlled trial of local corticosteroid injections for medial epicondylitis has demonstrated improved pain relief for the first six weeks after the Injection of the painful epicondyle, compared to NSAIDs and physical therapy, which were baseline treatments for both groups 4. The major concern in injecting the medial epicondyle is the potential to impale the ulnar nerve. This would have to be included in any consent for this procedure.
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| Class III evidence
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| There is Class III evidence concerning the treatment of medial epicondylitis.
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| Class IV evidence
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| Two case series of operations for medial epicondylitis have been reported The first considered the outcome in 35 elbows followed-up from a series of 38 consecutive operations 5. All had chronic symptoms before surgery, and excellent or good results were reported in all but one patient. At operation, the pathology was identified as a tear in the common origin of the flexor mass with varying degrees of inflammation.
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| Similar results were noted from the series of Oliverre at al 6 who studied 48 patients with refractory medial epicondylitis. All patients had pain relief postoperatively.
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| In the absence of better evidence, the similarity of treatment effects of surgery and corticosteroid injection provides weak, circumstantial support for the concept that medial epicondylitis can be treated in the same way as lateral epicondylitis.
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| ==RECOMMENDATION==
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| The treatment for medial epicondylitis should be as for lateral epicondylitis, bearing in mind the added risk of ulnar nerve injury if local injection is being considered.
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| ==REFERENCES==
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| 1. Hamilton PG. The prevalence of humeral epicondylitis: a survey in general practice. J R Coll Gen Pract 1986; 36:464-465.
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| 2. Bennett JB. Lateral and medial epicondylitis. Hand Clin 1994; 10:157-163.
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| 3. Leach RE, Miller JK. Lateral and medial epicondylitis of the elbow. Clin Sports Med 1987; 6:259-272.
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| 4. Stahl S, Kaufman T. The efficacy of an injection of steroids for medial epicondylitis. J Bone Joint Surg 1997; 79A:1648-1652.
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| 5. Vangsness CT Jr, Jobe FW. Surgical treatment of medial epicondylitis. Results in 35 elbows. J Bone Joint Surg 1991; 73B:409-411.
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| 6. Olliverre CO, Nirschl RP, Pettrone FA. Resection and repair for medial tennis elbow. Am J Sports Med 1995; 23:214-221.
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| [[Category:Elbow & Forearm]] | |
