top of page


Timothy F. Tyler, MS, PT, ATC, Stephen J. Nicholas, MD, [...], and Daniel E. Hogan, MS

Setting the scene:

The aim of this study is to assess the effectiveness of a novel eccentric wrist flexor exercise added to standard treatment for chronic medial epicondylosis in patients who did not respond to previous therapeutic interventions for this disorder.

What did they do?

Patients (13 men, 7 women; age 49±12 yrs) with chronic medial epicondylosis who had failed previous treatment for this disorder (physical therapy 7, cortisone injection 7, PRP 1, NSAIDS 15) were prescribed isolated eccentrics in addition to wrist stretching, ultrasound, cross friction massage, heat and ice. The specific isolated eccentric wrist flexor strengthening exercise performed by the patients involved twisting a rubber bar (Flexbar, Hygenic Corportation, Akron OH) with concentric wrist flexion of the noninvolved arm and releasing the twist by eccentrically contracting the wrist flexors of the involved arm (3 × 15 twice daily). A DASH questionnaire was recorded at baseline and again after the treatment period. Treating clinicians were blinded to baseline DASH scores. Treatment effect was assessed using paired t-test. Based on previous work it was estimated that with a sample of 20 patients there would be 80% power to detect a 13 point improvement in DASH scores (p<.05). Patients with a history of fracture, dislocation, surgery, medial epicondylar avulsion, osteochondritis dissecans or Osteochondritis of capitellum or radial head, olecranon apophysitis, cubital tunnel syndrome, flexor pronator strain, ulnar collateral ligament strain, and ulnar neuritis were excluded. All patients had failed various previous treatments for this pathology. Seven patients had prior physical therapy, seven patients had a corticosteroid injection one patient had a platlet- rich plasma injection, and 15 patients had taken non-steroidal anti-inflammatory medications. Two patients develops medial epicondylosis from playing tennis, 14 from golf, one during weight training, 1 from basketball, and two were attributable to activities of daily living. All subjects gave written informed consent and the protocol was approved by a North Shore/Long Island Jewish Health System Institutional Review Board.

Takeaway message:

Chronic medial epicondylosis was markedly improved with the addition of an eccentric wrist flexor exercise to standard physical therapy interventions. Given the inconsistent outcomes for patients previously treated with chronic medial epicondylosis the addition of isolated eccentrics seems warranted based on the results of this study. This novel exercise, using an inexpensive rubber bar, provides a practical means of adding isolated eccentric training to the treatment interventions for chronic medial epicondylosis.

bottom of page