Lateral Epicondylitis & Medial Epicondylitis
Lateral Epicondylitis, also known as tennis elbow, is irritation and inflammation of the muscles and tendons of the forearm and lateral elbow. These muscles include extensor carpi radialis longus and brevis, extensor digitorum, and extensor carpi ulnaris. Though these muscles branch out to help extend the fingers and wrist they have a common attachment point (the extensor bundle) on the lateral elbow.
Medial epicondylitis, or pitcher’s elbow/golfer's elbow, is the irritation and inflammation of the palm side forearm muscles and tendons of the medial elbow. These muscles include the pronator teres, the flexor carpi radialus, and the flexor carpi ulnaris. Though these muscles branch out to help flex the wrist and grip the hand/fingers, they have a common attachment (the flexor bundle) on the palm side of your elbow. Although this can occur with athletes 90-95% of incidences occur in non-athletes.
Though these conditions differ in what structures are affected they both are caused by repetitive wrist and forearm motions. Lateral epicondylitis is 5x more common than medial epicondylitis. Elbow tendonitis occurs most commonly in those aged 30-50.
Repetitive wrist extension and forearm supination (turning hand upwards) often lead to lateral epicondylitis.
Activities that include these motions are:
Repetitive wrist flexion and forearm pronation (turning palm down) often lead to medial epicondylitis.
Activities that include these motions are:
Signs and Symptoms of Lateral and Medial Epicondylitis:
Your PT will first determine if your presentation is tendonitis or tendinopathy in order to design your treatment plan accordingly:
Stages of Tendinopathy
Treatment may consist of:
Medial epicondylitis, or pitcher’s elbow/golfer's elbow, is the irritation and inflammation of the palm side forearm muscles and tendons of the medial elbow. These muscles include the pronator teres, the flexor carpi radialus, and the flexor carpi ulnaris. Though these muscles branch out to help flex the wrist and grip the hand/fingers, they have a common attachment (the flexor bundle) on the palm side of your elbow. Although this can occur with athletes 90-95% of incidences occur in non-athletes.
Though these conditions differ in what structures are affected they both are caused by repetitive wrist and forearm motions. Lateral epicondylitis is 5x more common than medial epicondylitis. Elbow tendonitis occurs most commonly in those aged 30-50.
Repetitive wrist extension and forearm supination (turning hand upwards) often lead to lateral epicondylitis.
Activities that include these motions are:
- Typing
- Tennis
- Opening Jars or Doors
- Driving
- Sewing
- Reading or holding objects for prolonged periods
Repetitive wrist flexion and forearm pronation (turning palm down) often lead to medial epicondylitis.
Activities that include these motions are:
- Texting or pushing buttons on a cellular phone
- Climbing
- Woodworking or carpentry
- Knitting
- Pitching
- Golf
- Lifting and carrying heavy objects
Signs and Symptoms of Lateral and Medial Epicondylitis:
- Localized tenderness or pain over the outside of the forearm near the elbow (Lateral Epicondylitis)
- Localized tenderness or pain over the inside of the forearm near the elbow (Medial Epicondylitis)
- Grip weakness
- Pain with wrist and hand movements
- Possible swelling or warmth in the elbow and forearm
Your PT will first determine if your presentation is tendonitis or tendinopathy in order to design your treatment plan accordingly:
- Tendonitis is an acute inflammation of the tendon due to short-term overuse.
- Tendinopathy is a condition due to chronic overloading and it can lead to tendon degeneration and changes in the tendon at the cellular level. With tendinopathy your tendons have healed from acute injury but the fibers have knitted back together haphazardly. This condition is not an inflammatory condition.
Stages of Tendinopathy
- Reactive Tendinopathy - Acute tendon overloading. There may be thickening of the tendon. Responds best to relative rest and pain/symptom management.
- Tendon Dysrepair - Occurs due to chronic tendon overloading and can occur if the tendon is not offloaded and allowed to regress back to the normal state from reactive tendinopathy. Responds best to appropriate tendon loading including isometric or eccentric strengthening
- Degenerative Tendinopathy - Partial tearing or degeneration of the tendon due to chronic overuse. This leads to changes in vascularization and tendon structure. Without treatment this tendinopathy is more at risk for rupture. Appropriate loading is essential to prevent further damage or rupture to the tendon.
Treatment may consist of:
- Manual interventions and stretching to improve muscle and tendon flexibility
- Appropriate exercises with isometric, eccentric, or concentric tendon loading as indicated to help restore strength and function
- Training for biomechanics for return to sport if necessary to allow for longevity of tendon health and reduce risk for reinjury
- Taping or splint as indicated to offload the tendon or to promote proper muscle activation