Inflammation of the growth zone in the elbow


The elbow joint is comprised of the upper arm bone (humerus), and one of the two forearm bones (ulna). The other forearm bone (radius) forms a joint with ulna (art. radioulnaris proximalis). A joint capsule and several strengthening ligaments surround the elbow joint. Two of the forearm’s large muscle groups are attached to the elbow, externally (lateral epicondyle), and internally (medial epicondyle), where a growth zone (apophysis) is found in adolescents which increases the risk of overload symptoms. The forearm muscles that are attached to the internal side of the elbow bend (flex) the wrist.

  1. M. biceps brachii
  2. Epikondylus mediale
  3. Aponeurosis m. bicipitis brachii
  4. M. pronator teres
  5. M. flexor carpi radialis
  6. M. palmaris longus
  7. M. flexor digitorum superficialis
  8. M. flexor carpi ulnaris


Cause: Repeated uniform loads on the forearm muscles (throwing, racket sports) cause an overload conditional inflammation with a fraying out of the bone at the point of attachment of the forearm muscles in the growth zone (apophysis) internally on the elbow (medial epicondyle) (article). The mechanism behind the development of ”inflammation of the growth zone” is identical to golf elbow for adults.

Symptoms: Slowly insetting pain on the internal side of the elbow (medial epicondyle) during and after the sports activity. With prolonged discomfort the bone fastening on the elbow will become more prominent. Boys in the 10-16 year age group are especially prone to developing the symptoms (article). The symptoms normally decline when the growth zone in the elbow closes at around age 17.

Acute treatment: Click here.

Examination: Pain when applying pressure on the inside of the elbow (medial epicondyle) which is aggravated when bending the hand against resistance, and when the forearm muscle group is stretched. A medical examination is usually sufficient to be able to make the diagnosis. If there is any doubt in the diagnosis it can occasionally be necessary to supplement with an ultrasound scan (or possibly x-ray), where a fraying out of the growth zone (apophysis) can usually be observed.

Treatment: Treatment comprises relief from the pain inducing activity (throwing, racket games) (article). If the treatment is begun very quickly, the injury can in some cases heal within a few weeks. The period of relief can be considerably longer if the pain has been present for several months. Special emphasis should be put on stretching the forearm muscles. Treatment with ice can be repeated every time the rehabilitation provokes tenderness at the muscle attachment in the elbow. With repeated pain in normal everyday life, medicinal treatment in the form of rheumatic medicine in gel form NSAID can be considered in the treatment. Injection of corticosteroid has no place in the treatment (article). The sports activity can be cautiously resumed when the pain has diminished. There will often be a recurrence of the symptoms, following which a period of relief should be started immediately. During the period of relief, it will usually be sufficient to refrain from the exercises which cause most strain on the injury (throwing, over-arm smashing), whilst many other training exercises can be performed without problems. It is only in very rare cases that an operation can become necessary (article)

Rehabilitation of children and adolescents: INSTRUCTION