Expert Health Articles

Medial and Lateral Epicondylitis

Larry Rosenberger IILarry Rosenberger II, MSN, FNP-C

Northwest Ohio Orthopedics and Sports Medicine

Warmer weather is here, meaning many of us have become more active, taking to tennis, golf, gardening, landscaping and handy work. Inevitably, with increased activity joints will ache and muscles will be sore. The elbow is a common site of pain due to overuse and increased activity. Two common conditions of the elbow are medial and lateral epicondylitis. These conditions are self-limiting but at times can be quite debilitating. 

Lateral epicondylitis, commonly referred to as tennis elbow, is pain on the outside of the elbow. This is the most common cause of elbow pain. Typically, individuals between the ages of 35 and 50 have a greater chance to develop tennis elbow. The pain associated with tennis elbow can be present during the activity or even at rest. When at its worst, using a cup, turning a key and shaking hands can become difficult. The pain is caused by degeneration of the tendon that attaches to the boney prominence on the outside of the elbow. On rare occasions, direct trauma can precipitate this condition. Activities that require repetitive rotation of the forearm with the elbow straight, such as the backswing in tennis, are the usual culprits. 

Medial epicondylitis, commonly referred to as golfers elbow, is pain on the inside of the elbow. This is less common than lateral epicondylitis. It is most likely to develop in the dominant extremity. The pain is caused by degeneration of the tendon that attaches on the boney prominence on the inside of the elbow. Activities that require wrist flexion or turning the thumb downward toward the ground such as the golf swing, throwing motion and swimming stroke, are the usual culprits. 

Your health care provider can diagnose these problems based on your symptoms and physical assessment. X-ray studies can be used to evaluate for arthritis or to rule out other painful conditions such as fractures. Magnetic resonance imaging (MRI) can be done to evaluate for tendon or ligament tears among other abnormalities.

Both conditions are treated very similarly. They are typically treated by modifying and/or eliminating the offending activity. A tension reduction strap, or cho-pat strap, can be used with activity to decrease pain. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or naproxen are often helpful. Topical creams, ice and heat can also be used. Your health care provider may prescribe physical therapy and use cortisone injections to help relieve your symptoms. Newer treatments such as platelet rich plasma injections are also available, however insurance coverage is currently limited. If symptoms persist despite weeks to months of activity modification, rest, bracing, over-the-counter medication, physical therapy and injections surgery can be done to repair the degenerated tendon.