(Medial Elbow Muscle Injury)
Sudden inner-elbow pain after a heavy hit or throw?
Rest, ice and early assessment prevent small tears becoming long-term problems.
What is a flexor-pronator strain?
- A muscle tear or overstretch in the five forearm muscles that start from the inner elbow (medial epicondyle) and help you grip, flex the wrist and turn the palm down (pronate).
- Injuries range from micro-tears to a complete rupture, usually a few centimetres below the bony point of the elbow.
Who gets it?
|
High-risk groups |
Why? |
|
Overhead throwers (cricket bowlers, baseball pitchers) |
Repetitive valgus stress and rapid forearm pronation |
|
Golfers & tennis players |
Powerful wrist-flexion at impact |
|
Gymnasts & weight-lifters |
Forceful gripping with elbows extended |
Typical symptoms
- Sharp or deep ache on the inner elbow after a single effort or repeated sessions
- Swelling or bruising within 24 h (acute tear)
- Pain on resisted wrist flexion or pronation
- Throwers: loss of control or speed in the late cocking / early acceleration phase
- Possible tingling in ring & little fingers if the ulnar nerve is irritated
Why imaging matters
|
Test |
What it shows |
|
X-ray |
Usually normal; rules out fracture or loose body |
|
MRI (gold standard) |
Grades the tear, confirms partial vs complete rupture, screens the ulnar collateral ligament (UCL) |
|
Ultrasound |
Dynamic, low-cost view for tendon thickening or hypoechoic defects |
Key anatomy snapshot
Common flexor-pronator mass (from medial epicondyle):
- Pronator teres (median n.)
- Flexor carpi radialis (median n.)
- Palmaris longus (median n.)
- Flexor digitorum superficialis (median n.)
- Flexor carpi ulnaris (ulnar n.) – largest contributor to dynamic valgus stability
These muscles act as a “living sling” for the UCL, absorbing valgus forces during throwing and racket sports.
Treatment roadmap (non-operative in > 90 %)
|
Phase |
Goals & actions |
Usual timing* |
|
Acute (0–7 d) |
RICE, NSAIDs, gentle wrist/elbow ROM |
Pain settles |
|
Early rehab (1–3 wk) |
Isometric forearm squeezes, shoulder & scapula control |
Pain-free ROM |
|
Strength / endurance (3–6 wk) |
Eccentric wrist curls, pronation-supination with tubing, core & hip work |
Full strength w/out pain |
|
Return-to-play (6–12 wk) |
Graduated throwing or swing programme, kinetic-chain drills |
Sport-specific |
*Elite programmes often progress faster but never through pain.
Surgery (direct repair) is reserved for complete ruptures with > 2.5 cm retraction or failures after thorough rehab.
Common rehab pitfalls
- Skipping warm-up – cold tissue tears again.
- Rushing load – gripping weights or swinging clubs too soon reignites pain.
- Ignoring kinetic chain – weak hips/torso make the elbow over-work.
- Neglecting nerve symptoms – persistent tingling warrants nerve-glide exercises or splinting.
Self-help & prevention tips
- Keep a balanced forearm programme: flexors and extensors.
- Use proper grip size on bats, clubs or racquets.
- Limit sudden spikes in training volume or intensity (max 10 % per week).
- Build shoulder and trunk rotation strength to share the load when throwing.
Patient FAQs
Is this the same as “golfer’s elbow”?
Different—golfer’s elbow is tendon degeneration at the epicondyle; flexor-pronator strain is a muscle injury just below it.
Do I need a brace?
A light counter-force strap can reduce early pain but should not replace proper rehab.
When can I return to sport?
Most non-surgical cases resume full play in 8–12 weeks once strength and technique are symmetrical.
Could it damage my UCL?
Untreated strains may overload the ligament. Rehab strengthens the dynamic support and protects the UCL.
Call- Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025