Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Medial Elbow Injuries

Thrower’s elbow or golfer’s elbow (medial epicondylitis, medial elbow tendinosis)

Thrower’s or golfer’s elbow is similar to tennis elbow, but the symptoms are located over the inner (medial) epicondyle of the elbow. A right-handed golf player may well suffer from tennis elbow in the (leading) left elbow and golfer’s elbow in the (following) right elbow. Thrower’s elbow is most common in javelin throwers, but also occurs in cricket and baseball players.

The primary pathological changes involved in medial tennis elbow are present in the origin of the pronator teres, palmaris longus, and flexor carpi radialis, close to the attachment of the medial epicondyle.
Occasionally pathological changes also occur in the flexor carpi ulnaris.

The etiology of medial elbow tendinosis is the same as for lateral tendinosis. The majority of cases are due to faulty technique; however, top-level tennis players may develop medial epicondylitis owing to a serving action during which the wrist is bent at the same time as the forearm is turned inwards. Those who hit an xaggerated ‘top spin’ serve and in so-doing rotate the forearm vigorously inwards (excessive pronation) can also be affected. The flexor muscles that are principally responsible for these movements have their origins at the medial epicondyle of the elbow.

Symptoms

The symptoms are similar to those of tennis elbow (p. 162) but are located on the inner aspect of the elbow. There is pronounced tenderness when the medial epicondyle is subjected to pressure, and flexing the hand downwards (palmar flexion) at the wrist joint against resistance causes pain.

Treatment

The treatment is the same as for tennis elbow. However, rehabilitation can sometimes take a little longer after surgery.

The prognosis for medial elbow tendinosis is worse and the healing time is longer than for the lateral side. It can sometimes take 6–12 months before a return to tennis is possible. Patients should be told this so that
their expectations are realistic.

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