Golfer's elbow and resisted wrist flexion
Golfer's elbow (medial elbow tendinopathy) is a painful, degenerating tendon on the inner elbow, where the forearm muscles that flex the wrist and turn the palm down start.
Remember
Inner-elbow pain reproduced by resisted wrist flexion or forearm pronation points to golfer's elbow, whatever the sport, whereas tennis elbow is lateral and hurts on wrist extension.
Memory aid
golfers aim for the middle of the fairway and tennis players for the lateral line of the court
Use the picture to place the side: golfer's elbow is medial and tennis elbow is lateral.
Golfer's elbow, also called medial elbow tendinopathy, is a problem of the common flexor origin. A tendinopathy is a painful, degenerating tendon, usually from repeated load. The common flexor origin is the shared tendon from which the forearm flexor and pronator muscles (those that flex the wrist and turn the palm down) start, on the medial epicondyle, the bony bump on the inner side of the lower humerus.
The pain is felt over the medial epicondyle during resisted wrist flexion or forearm pronation. Pronation is turning the palm down. A resisted movement is one in which the patient contracts a muscle while the examiner holds the joint still, so the sore tendon is loaded without the joint moving.
The condition is less common than lateral elbow tendinopathy, and golf and throwing sports are the usual associations. These sports place valgus stress on the elbow, which is a sideways force that tends to open up the inner side of the joint. The sport does not decide the diagnosis. Tennis elbow is the lateral condition: it affects the common extensor origin on the outer side of the elbow and hurts on wrist extension. A tennis player with inner-elbow pain on resisted wrist flexion and pronation has golfer's elbow.
The ulnar nerve runs just behind the medial epicondyle, so ulnar nerve symptoms may coexist with golfer's elbow. The diagnosis is made clinically, from pain over the medial epicondyle that is reproduced by resisted wrist flexion or pronation, without laxity (the joint opening up too far under sideways stress) or locking (the joint being mechanically blocked). The condition is self-limiting, which means it usually resolves without treatment if the arm is rested.
Key facts
- Site
- the common flexor origin on the medial epicondyle, on the inner side of the elbow.
- Provoking test
- pain over the medial epicondyle on resisted wrist flexion or forearm pronation.
- Usual association
- golf and throwing sports, which place valgus stress on the elbow.
- Mirror image
- tennis elbow is the lateral condition, at the common extensor origin, and it hurts on wrist extension.
- Nerve link
- ulnar nerve symptoms may coexist.
- Self-limiting
- it usually resolves without treatment if the arm is rested.
Exam traps
- Pain on resisted wrist extension points to tennis elbow, not golfer's elbow, because the extensor muscles (those that extend the wrist) share an origin on the outer side of the elbow.
- Damage to the ulnar collateral ligament, which runs from the medial epicondyle to the ulna, causes valgus instability, where sideways stress makes the inner side of the elbow open up, and not pain on resisting the wrist flexors and pronators.
- Triceps tendon trouble sits at the back of the elbow, where the tendon attaches to the olecranon (the point of the elbow), so it does not explain inner elbow pain provoked by resisted wrist flexion or pronation.
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