Castro Domínguez Francisco

Medial epicondylitis, commonly known as "golfer's elbow," is a painful condition that affects the elbow region. Despite its name, this condition is not limited to golfers, as it can affect anyone who makes repetitive movements of the arm and wrist.

The diagnosis of medial epicondylitis is based primarily on the patient's history and physical examination. Below are the key aspects of the diagnosis:

The doctor will begin by obtaining a detailed medical history of the patient. This will include questions about the nature and duration of the pain, activities that trigger or aggravate symptoms, and any history of previous elbow injuries.

During the physical examination, the doctor will evaluate the elbow for signs of medial epicondylitis. One of the characteristic findings is tenderness and pain on palpation at the medial epicondyle of the elbow, which is the bony prominence on the medial side of the elbow.

Specific resistance tests may be performed to evaluate the strength and function of the affected muscles and tendons. In medial epicondylitis, testing may include resistance to flexion of the wrist and resistance to pronation of the forearm.

Mobility tests may be performed to evaluate the range of motion of the elbow and wrist. This helps determine if joint function is compromised.

The doctor may also perform additional tests, such as ultrasound, or MRI, to rule out other conditions that may cause similar symptoms, such as fractures, arthritis, or nerve problems.

Medial epicondylitis can present different phenotypes or patterns of presentation, and can be classified based on its severity and chronicity:

• Acute Medial Epicondylitis: In acute cases, symptoms usually appear suddenly and are associated with a traumatic injury or a sudden increase in activity involving the wrist and forearm. The pain is intense and can significantly limit function.
• Chronic Medial Epicondylitis: In chronic cases, symptoms may have been present for weeks or months. The pain tends to be more constant, but may be less intense than in the acute phase. Limitation of function and muscle weakness may be more pronounced in chronic cases.
• Recurrent Medial Epicondylitis: Some people experience recurring episodes of medial epicondylitis, in which symptoms improve but then worsen again due to repetitive activity or lack of proper medical care.

Treatment:

Treatment of medial epicondylitis is based on the severity of the condition and its impact on the patient's quality of life. The most common treatment options are described below:

Conservative Management:

• Rest: Resting the arm and avoiding activities that trigger symptoms is essential in the initial stages.
• Physical Therapy: Strengthening and stretching exercises supervised by a physical therapist can help improve strength and flexibility in the affected area.
• Massage therapy and myofascial release techniques: These therapies can help reduce muscle tension and improve blood flow to the affected area.
• Immobilization: In some cases, the use of a splint or bandage may be recommended to limit elbow mobility and reduce stress on the tendons.

Medicines:

Nonsteroidal anti-inflammatory drugs (NSAIDs)can relieve pain and reduce inflammation in mild to moderate cases.

In some cases, corticosteroid injections may be given directly into the epicondyle to reduce inflammation and pain.

Advanced Therapies:

• Shock wave therapy: This therapy uses high-energy sound waves to stimulate healing of affected tissues.
• Platelet Rich Plasma (PRP) therapy has been used in some cases. This therapy involves injecting a concentration of the patient's own platelets into the affected area to promote tissue regeneration.

Surgery:

In severe cases or cases that do not respond to conservative treatment, surgery may be considered to remove damaged tissue and repair the tendons. This option is generally reserved for cases that are chronic or do not improve with other approaches.