What is Medial Epicondyle Injection?
Tendinosis, a common cause of elbow pain, is often seen in both athletes and regular people, mainly due to excessive use. The condition, frequently known as golfer’s elbow or little leaguer’s elbow, affects the inside part of the elbow, specifically where the flexor-pronator muscle group begins (see Images. Golfer’s Elbow, Medial Elbow Anatomy). The muscles usually affected in this condition are called the pronator teres and the flexor carpi radialis.
The location at the issue is the medial epicondyle; it’s a spot on your humerus bone (the bone of your upper arm) just outside of your elbow joint. This area acts as the starting point of important structures like the ulnar collateral ligament, pronator teres, and the common flexor tendon. The latter is made up of the tendons from several muscles, including the flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, and the palmaris longus. This tendon complex helps to achieve stability against forces coming from various directions. The ulnar collateral ligament is mainly responsible for preventing instability towards the inside of the elbow and comprises three parts: anterior, posterior, and transverse. The ulnar nerve, another important structure, runs behind the medial epicondyle in a groove called the ulnar groove (inside the cubital tunnel). Refer to the image for a better understanding of these parts, titled ‘Left Elbow Joint, Anterior and Internal Ligaments’.
What Causes Medial Epicondyle Injection?
Repeatedly twisting your forearm and bending your wrist can cause damage to the tendons that help you flex and twist your arm. These tendons are attached to a spot on the inside of your elbow called the medial epicondyle. Over time, this overuse can lead to wear and tear, a condition sometimes known as “medial epicondylitis”.
While it’s not very common, hard impact or a sudden intense contraction of the wrist flexors can result in a sudden onset of medial epicondylitis.
Risk Factors and Frequency for Medial Epicondyle Injection
Research shows that medial epicondylitis, a condition affecting the elbow, occurs in about 0.4 to 0.6% of working adults. A study on the US military reported a rate of 0.81 cases per 1000 people every year. While this condition can affect people of all ages, it’s most common in people in their 40s and 50s and typically affects the arm they use the most.
Medial epicondylitis affects men and women equally. However, it’s less common than lateral epicondylitis, making up less than 20% of all elbow pain diagnoses. Jobs that involve a lot of upper arm movement, especially bending and straightening the elbow repeatedly, can raise the risk of this condition. Sports that put continual strain and flexing on the elbow, like golf, baseball, and bowling, can also increase the risk.
- The prevalence of medial epicondylitis among working adults is 0.4 to 0.6%.
- A study within the US military reported an incidence rate of 0.81 per 1000 person-years.
- The condition commonly affects people in their 40s and 50s and often involves the dominant arm.
- Both men and women can be affected.
- Medial epicondylitis is less prevalent than lateral epicondylitis, forming less than 20% of all elbow pain diagnoses.
- Jobs demanding repetitive upper arm movements, especially repeated bending and straightening the elbow, increase the risk of this condition.
- Sport activities like golf, baseball, and bowling that demand repetitive strain and flexing of the elbow also heighten the risk.
Signs and Symptoms of Medial Epicondyle Injection
Medial epicondylitis, often referred to as golfer’s elbow, is a condition that causes pain to develop on the inner side of your elbow. The pain gradually worsens and increases with physical activity. The severity and intensity of the pain can range from mild and occasional to severe, leading to significant discomfort and difficulty in moving the arm. During physical examination, a healthcare professional will notice that the inner part of the elbow and the adjoining tendons are sensitive to touch.
The evaluation process might also include checking your arm’s strength and mobility. Pain can occur when you flex your wrist or rotate your arm, especially when your elbow is fully straightened. Over time, if the condition becomes chronic, you might experience a decrease in the movement range of your wrist or difficulty when trying to extend it. You may also notice a decrease in grip strength.
Healthcare professionals will also ensure that there is no pain in the ulnar collateral ligament and the ulnar nerve in your arm, which are structures adjacent to the site of medial epicondylitis. You may undergo tests to assess the stability and sensitivity of these structures, and to rule out other similar conditions. You may also require a neurological examination focusing on the sensation in your fifth finger, which shares the same nerve supply with the affected area. This thorough evaluation is important as 60% of people with medial epicondylitis may have nerve-related issues.
Testing for Medial Epicondyle Injection
Medial epicondylitis, also known as golfer’s elbow, is a condition that’s typically diagnosed through a medical examination – it usually doesn’t need imaging tests. However, in cases where the condition doesn’t improve as expected, X-rays might be used to check for other health issues that might be causing the symptoms. Although MRI and ultrasound are able to show changes in the tendon often seen in medial epicondylitis, they aren’t necessary to confirm the diagnosis.
Treatment Options for Medial Epicondyle Injection
Epicondylitis, which is a condition that affects the elbow, is usually managed without needing surgery. In fact, over 95% of patients get better with non-surgical treatments. Without any treatment, symptoms can typically last from 6 months to 2 years. The most effective treatments include rest, cold compresses, pain relief medication, wearing a brace, and physical therapy. For both athletes and non-athletes, it’s essential to rest and modify activities for at least six weeks.
In the early stages of epicondylitis, when there’s inflammation, ice packs, compression, and elevation of the elbow can provide relief. As the condition becomes chronic, meaning it lasts for a long time, these treatments might not be as effective. Pain relief medication called non-steroidal anti-inflammatory drugs (NSAIDs) are often used, although there’s limited evidence showing their effectiveness. Some studies have shown that NSAIDs applied on the skin can provide short-term pain relief, but findings have been mixed for NSAIDs taken by mouth.
Bracing, involves wearing a strap around the elbow to decrease strain on tendons, can often help reduce pain and improve function over the short term. Splints worn on the wrist that limit its movement can also reduce pain, but because they can potentially prolong symptoms, they should only be used in severe cases.
Physical therapy can help you restore strength and flexibility in your elbow. Some techniques used in physical therapy, such as exercises specifically designed for elbow tendinitis, can improve function and decrease pain. You might also benefit from treatments that promote better movement of the soft tissues in your elbow.
Patients have also found relief through using patches containing glyceryl trinitrate, a substance that promotes healing by stimulating the production of collagen. When these patches are used along with physical therapy, patients have shown improvements in pain and function.
If other treatments don’t work, or if your symptoms are severe, your doctor might consider giving you a corticosteroid injection in your elbow. This can improve pain in the short term, which is generally under 12 weeks.
In some cases, injection of your own blood (autologous blood) or plasma rich in platelets (PRP) might improve symptoms over the medium term. However, due to inconsistent findings, these treatments aren’t usually recommended.
Other injections, like prolotherapy and botulinum toxin A, have been shown to be as effective as corticosteroid injections in reducing pain.
Surgery is rarely needed for epicondylitis. But in cases where the pain is severe or there’s significant dysfunction that doesn’t respond to non-surgical treatments over a long period, surgery might be considered.
What else can Medial Epicondyle Injection be?
Medial epicondylitis is a condition that causes pain on the inside of the elbow. However, it’s important to figure out if this elbow pain is actually due to medial epicondylitis or if it’s caused by something else. Some other conditions that can cause similar pain include:
- Ulnar nerve entrapment, a condition where a nerve in the elbow gets compressed or irritated
- Ulnar nerve subluxation, when the ulnar nerve moves out of its normal place
- Ulnar collateral ligament insufficiency, or a weak or damaged ligament in the elbow
- Osteoarthritis, a deterioration of joint cartilage and the underlying bone
- Little league elbow, a common injury in young baseball players
- Osteochondritis dissecans, a joint condition where cartilage separates from the bone
- Posteromedial elbow impingement, a condition leading to restricted elbow motion and pain
It’s crucial to understand the exact cause of elbow pain to be able to provide the most successful treatment.
What to expect with Medial Epicondyle Injection
Data regarding the outcomes of injections for medial epicondylitis, a condition causing pain on the inside of the elbow, is limited. Most of our understanding about treating this condition comes from studies on lateral epicondylitis, a similar condition that affects the outside of the elbow.
Despite the fact that medial epicondylitis isn’t typically associated with inflammation, corticosteroids – anti-inflammatory medication – are often used to alleviate pain that stems from the nervous system. These corticosteroids are effective in providing short-term pain relief. However, They don’t seem to present a lasting benefit, as there is frequently a recurrence of pain and no apparent benefit at the end of a year when compared to a combination of observation and physical therapy.
Because of this, corticosteroid injections should be used as a part of a larger treatment plan that includes other non-surgical therapies. Comparisons made between single and multiple ‘peppered’ injections of corticosteroids found that the ‘peppered’ technique, where multiple injections are made in a pattern, gave better results.
Possible Complications When Diagnosed with Medial Epicondyle Injection
Several complications might occur during or after medical procedures. These potential complications are:
- A temporary vasovagal reaction, which is a sudden drop in heart rate and blood pressure leading to fainting
- Bleeding
- Infections
- A sudden increase in pain levels
- Thinning and shrinking of skin and fat layers
- Damage to the ulnar nerve, a main nerve in the arm
- Increased degeneration of the tendon, resulting in worsening conditions
- A significant increase in pain and decrease in function after three months
Preventing Medial Epicondyle Injection
After receiving a corticosteroid injection in the medial epicondyle (inside part of your elbow), patients should take it easy for a while. They should be aware that there could be a short-term increase in pain, known as a steroid flare. This can be managed with cold compresses, painkillers like acetaminophen, and anti-inflammatory drugs (NSAIDs).
Patients should continue to adjust their activities and follow other treatments until the pain lessens. Before they go back to their jobs or sports, it’s crucial they receive guidance on proper movement techniques. A gradual increase of exercises specific to their sport is neccesssary for a successful return. Typically, these changes and treatments are needed for a total period of 6 to 12 weeks. This is to make sure that the patient can resume their activities safely and without pain.