Management of Medial Epicondylitis

Initial Diagnosis and Assessment

• Radiographs are beneficial as the initial imaging for chronic elbow pain to rule out other pathologies such as intra-articular bodies, heterotopic ossification, osteochondral lesions, soft tissue calcification, or occult fractures 1, 3

First-Line Treatment (Conservative Management)

• The American Academy of Family Physicians recommends rest and activity modification, including avoiding activities that require repetitive wrist flexion and forearm pronation, to manage medial epicondylitis 2, 3
• The American College of Radiology suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for pain relief in patients with medial epicondylitis 2
• Eccentric strengthening exercises for the wrist flexors, as well as deep transverse friction massage, can help reduce pain and improve function in patients with medial epicondylitis 2

Second-Line Treatment

• The American Academy of Family Physicians recommends considering corticosteroid injections for patients with persistent symptoms despite first-line treatment, as they may be more effective than NSAIDs in the acute phase 1, 2
• Extracorporeal shock wave therapy (ESWT) has shown mixed results but may be considered as an alternative therapy for medial epicondylitis 2

Common Pitfalls and Caveats

• Overreliance on corticosteroid injections without addressing underlying biomechanical issues can be a common pitfall in the management of medial epicondylitis 2