Golfer's Elbow (Medial Epicondylitis): AI-Powered MRI & X-ray Analysis

Medial epicondylitis involves degenerative tendinopathy of the common flexor–pronator tendon origin at the medial epicondyle. The flexor carpi radialis and pronator teres are most frequently and severely affected, as they bear the highest tensile load during activities that combine wrist flexion and forearm pronation such as a golf swing, throwing, or racket sports. The palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis origins can also be involved. Histopathology shows angiofibroblastic hyperplasia with disorganized collagen, immature fibroblasts, and vascular proliferation, identical to the changes seen in lateral epicondylitis.

The moving valgus stress test assesses pain arising from the ulnar collateral ligament, not the common flexor tendon. An examiner applies valgus stress while extending the elbow; reproduction of ligament pain, greatest between 120 and 70 degrees of flexion, supports ligament involvement. It is not a stand-alone diagnosis of medial epicondylitis.

Corticosteroid injection into the common flexor–pronator tendon origin can provide short-term pain relief of 4 to 8 weeks but has not been shown to improve long-term outcomes compared to physical therapy alone. Injection must be performed carefully to avoid inadvertent UCL infiltration, which could weaken the ligament in throwing athletes, and to avoid intraneural injection near the ulnar nerve. Given risks of tendon attenuation and cartilage toxicity, repeated injections are discouraged. Platelet-rich plasma injection has shown promise in small trials as a biologically active alternative that may promote tendon healing without the catabolic effects of corticosteroids.