QuestionSBA
QuestionChoice
This is most likely to be affected in tennis elbow, which results from lateral epicondylitis as the radial nerve travels anterior to the lateral epicondyle to enter the forearm. Pain is exacerbated in resisted wrist extension or supination. It may lead to radial nerve entrapment syndrome, causing wrist drop, loss of sensation to the anatomical snuff box and radial 3.5 digits on the dorsum of the hand
32129
b
Radial nerve
QuestionChoice
This is golfer's elbow, which results from medial epicondylitis. The ulnar nerve may be compressed as it passes through the ulnar groove, which lies posterior and lateral to the medial epicondyle, resulting in numbness and/or tingling in the 4th and 5th fingers
32128
a
Ulnar nerve
QuestionChoice
If median nerve injury occurs more proximally at the elbow (most commonly due to a supracondylar fracture of the humerus), this may result in a hand of benediction (inability to flex the 2nd and 3rd fingers when making a fist) and paralysis of the flexors and pronators of the forearm. Sensation to the palmar aspect of the lateral 3.5 fingers may also be affected
32130
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Median nerve
QuestionChoice
Isolated musculocutaneous nerve lesions are rare. This would result in weakness of elbow flexion and forearm supination, weak biceps tendon reflex and sensory loss over the lateral surface of the forearm
32131
d
Musculocutaneous nerve
QuestionChoice
This is most commonly damaged by direct trauma to the shoulder or proximal humerus, such as in fracture of the surgical neck of the humerus or shoulder dislocation. It would result in regimental badge numbness (over the inferior portion of the deltoid) and inability to abduct the affected shoulder due to deltoid and teres minor muscle weakness
32132
e
Axillary nerve
Concept
Chapter
# Summary

Medial epicondylitis, also known as 'golfer's elbow', is a condition resulting from tendinopathy of the wrist flexor tendons attaching to the medial epicondyle of the distal humerus. Patients typically present with gradual-onset medial elbow pain, which is exacerbated by activity, especially wrist flexion, and may also report wrist flexion weakness. The diagnosis is primarily clinical. Key investigations may include physical examination, MRI, and ultrasound. Management strategies predominantly involve conservative measures such as rest and guided rehabilitation, with surgical debridement as a potential course of action for cases unresponsive to six months of non-surgical treatment.

# Definition

Medial epicondylitis, or 'golfer's elbow', is a condition that arises due to tendinopathy of the wrist flexor tendons, which attach to the medial epicondyle of the distal humerus. The primary tendons involved include the flexor carpi radialis, pronator teres, palmaris longus, flexor digitorum superficialis, and flexor carpi ulnaris.

# Epidemiology

Medial epicondylitis most commonly affects individuals between 20 and 50 years of age. The condition is more prevalent in athletes or those involved in repetitive activities that stress the involved tendons. Despite its moniker "golfer's elbow," it can affect individuals from various occupations and recreational backgrounds.

# Aetiology

Medial epicondylitis typically results from overuse and strain of the muscles and tendons involved in wrist flexion and forearm pronation. It often occurs due to repetitive strain, especially in sports like golf, but it can also arise from occupational activities that involve repetitive wrist flexion or twisting motions.

# Signs and Symptoms

Patients generally report a gradual onset of medial elbow pain that worsens with activity, particularly during wrist flexion. Additional symptoms may include weakness of wrist flexion and a decreased range of motion in the affected arm.

# Differential Diagnosis

The main conditions to consider in the differential diagnosis include:

-   **Lateral Epicondylitis ('Tennis Elbow')**: Characterised by pain and tenderness over the lateral aspect of the elbow, exacerbated by wrist extension.
-   **Olecranon Bursitis**: Presents with swelling and pain at the back of the elbow.
-   **Cubital Tunnel Syndrome**: Marked by numbness or tingling in the ring and little fingers, weakness in the hand, and pain on the inside of the elbow.
-   **Ulnar Neuropathy**: Symptoms can include numbness and tingling in the fourth and fifth fingers, elbow pain, and weakness of the hand.

# Investigations

The diagnosis of medial epicondylitis is primarily clinical. Physical examination can reveal pain and tenderness at the medial epicondyle, exacerbated by resisted wrist flexion and forearm pronation. If the clinical presentation is unclear, imaging modalities such as MRI or ultrasound may be utilized to confirm the diagnosis and assess the extent of the lesion.

# Management

Medial epicondylitis is generally managed conservatively with rest and guided rehabilitation, which can include physical therapy, pain management with NSAIDs, and corticosteroid injections. Surgical debridement of damaged tissue may be indicated in cases which do not respond to six months of non-surgical management.

# External links

-   [Physiopedia: Medial Epicondyle Tendinopathy](https://www.physio-pedia.com/Medial_Epicondyle_Tendinopathy)
-   [Ortho Bullets: Medial Epicondylitis (Golfer's Elbow)](https://www.orthobullets.com/shoulder-and-elbow/3083/medial-epicondylitis-golfers-elbow)
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Medial epicondylitis
Topic
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Orthopaedics
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Ulnar nerve compression can cause tingling in the 4th and 5th fingers, often associated with medial epicondylitis or golfer's elbow.
A 30-year-old male presents to his GP with a two-month history of persistent right elbow pain. He describes a tingling sensation in the 4th and 5th fingers. On examination, the pain is aggravated by wrist flexion and pronation of the arm.

Which single nerve is involved?
a