Inner Elbow Pain – Medial Epicondylitis

Inner elbow pain is most often caused by what is known as medial epicondylitis or golfer’s elbow. The muscles between the wrist and the elbow, which allow us to bend the wrist inward, attach to the humerus on the inside of the elbow. The muscles that allow us to turn our palms inward also attach here.

Where the muscles attach to the bone, they turn into strong connective tissue fibers called tendons. In a trauma that forces the forearm muscles suddenly or due to excessive repetition of certain movements, the tendons can be worn, injured, swollen and painful. In medial epicondylitis, pain is felt when pressing on the bony prominence on the inner side of the elbow. Although it is called golfer’s elbow, it can develop in any activity that uses the arm and wrist.

Pain on the outer side of the elbow is usually caused by a problem called lateral epicondylitis. Lateral epicondylitis is a more common problem than medial epicondylitis.

Medial Epicondylitis – Golfer’s Elbow Symptoms

Medial epicondylitis can occur suddenly or gradually over days to weeks. Complaints can be mild, moderate or severe. It usually affects the person’s dominant arm (the side on which they are writing). Its symptoms are:

  • Pain on the inside of the elbow
  • Stiffness in elbow movements
  • Pain when moving the elbow
  • Weakness in finger and wrist movements (especially if the problem persists for a long time)
  • Numbness and tingling sensation in the fingers, especially in the little finger and ring finger. The ulnar nerve passes from the inside of the elbow. This nerve receives sensation from the little finger, ring finger, and skin on that side of the forearm, stimulating the hand muscles. Up to 20% of athletes with medial epicondylitis also have symptoms such as numbness and tingling due to ulnar nerve injury.
  • Medial epicondylitis pain can radiate from the elbow to the wrist, making it difficult to do daily activities. Activities such as grasping, lifting, squeezing, opening doors, shaking hands can become painful.
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What Causes Medial Epicondylitis?

Overuse injury is the main cause of medial epicondylitis. It is a common problem in athletes. It is called goalkeeper’s elbow because tendinitis can occur in the elbow as a result of repeatedly swinging the golf club. In fact, it can occur frequently in athletes engaged in tennis, rowing, archery, baseball, bowling, and weight lifting. Playing a musical instrument and working with a computer can also cause this problem. Tendons are strained and damaged as a result of overuse. This causes symptoms such as weakness in the related muscles, pain in the elbow, stiffness in joint movements.

The mistakes of the athletes such as neglecting the warm-up movements and suddenly increasing the intensity of the training increase the risk of encountering this problem. Attention should be paid to the correct application of techniques specific to each sport. For example, tennis players can reduce their risk of elbow injury if they practice hitting techniques correctly.

How is the diagnosis made? Which Department to Go to for Elbow Pain?

If you have pain in the inner side of the elbow and your pain has not decreased in a few days, you can be examined by a physical therapy and rehabilitation doctor. The doctor first listens to your complaints. He asks when and how the symptoms occur, the reasons that increase and decrease the pain. He or she may ask about your trauma history, occupational conditions, sports you do, and other habits/hobbies.

During the examination, he evaluates features such as the general appearance of the elbow, range of motion, places sensitive to pressure, strength of the wrist and elbow. Medial epicondylitis checks for pain by performing specially defined maneuvers. The most commonly used of these maneuvers is to ask the patient to bend the wrist against the resistance, while asking whether there is pain in the inner edge of the elbow. In addition, the movement of palm-turning (forearm pronation) against resistance can also be painful. In chronic and advanced cases, bending the elbow against resistance by the patient may also cause pain. To test for damage to the ulnar nerve, tap the area where the nerve is close to the skin with a finger to look for pain and tingling (Tinel test).

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Especially in baseball players, the inner lateral ligament of the elbow, called the ulnar collateral ligament (UCL), should also be checked. Weakness or insufficiency in this ligament may be the main cause of complaints on the inner side of the elbow. If in doubt, MRI of the elbow joint can be performed to differentiate UCL damage from medial epicondylitis.

In general, questioning the complaints and physical examination are sufficient to diagnose medial epicondylitis. Elbow X-ray can be taken to exclude other possible causes such as bone damage, joint calcification, rheumatism.

Another possible cause of pain in the inner side of the elbow is neck hernia . Although there is pain in the elbow in a hernia, the pain usually starts from the neck and spreads to the arm. Neck pain and stiffness may accompany.

Treatment

If the inner side of the elbow pain is due to medial epicondylitis, it is mostly relieved with home remedies. However, in some cases, the pain may persist. Then, different treatments such as physical therapy and injection may be required.

The first-line methods in the treatment of medial epicondylitis are rest, cold application , pain relievers , stretching exercises and the use of elbow braces.

Since it is mostly a problem that develops as a result of overuse or trauma, it is helpful to stop activities that increase pain and rest in order for the tissues to heal. After the pain subsides, you can gradually return to activities. During this time, the use of an elbow brace or epicondylitis tape may be beneficial.

Applying cold to the elbow for 15-20 minutes 3-4 times a day can reduce edema and pain.

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Simple painkillers relieve pain and swelling as well as reduce inflammation. In order to avoid possible drug side effects, you should be careful to use it in accordance with your doctor’s prescription.

Stretching exercises can be helpful to stretch the tendons. Your doctor or physiotherapist can show you the appropriate exercises.

If there is no improvement with these methods, physical therapy methods such as TENS, low-energy laser, ultrasound, ESWT can be used. PRP or corticosteroid injections may be helpful.

Orthopedic surgeons may perform an operation called medial epicondylar release as a last resort in cases with no improvement.

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