21 Medial Epicondylitis / Carpal Tunnel
This module teaches the release of the palmar flexor system, which can contribute to both medial epicondylitis and carpal tunnel symptoms.
Step 1
Understanding the Problem
Medial epicondylitis and carpal tunnel syndrome are often treated as separate conditions.
In practice, they frequently share a common muscular source: the palmaris longus and its associated flexor tension pattern.
The palmaris longus runs from the medial epicondyle down into the palm through a long central tendon.
When it enters spasm, it can create:
• pulling at the medial elbow
• tension through the flexor forearm
• compression into the palm and wrist
This is why a client may present with both:
• medial elbow pain
• numbness or tingling into the hand
The symptoms appear to be separate.
The cause is often one continuous line of tension.
Step 2
The Clinical Problem
Step 1: Understanding the Problem
Medial epicondylitis and carpal tunnel syndrome are often treated as separate conditions. In practice, they are the same fundamental problem. The palmaris longus and its associated carpal flexors are in spasm
The palmaris longus runs from the medial epicondyle down into the palm through a long central tendon. When it enters spasm, it can create:
• pulling at the medial elbow
• tension through the flexor forearm
• pulling on the flexor retinaculum, pulling it up the forearm like pulling on a sock
• entrapment of the median nerve where they entertwine on their path under the flexor retinacuolum. the palmaris longus has a tendon sheath that runs along with and next to the median nerve and where they cross under the retinaculum
• the palmaris longus teminates as three tendons that attach to the base of the metacarpal bones. These bones are directly connected, via mc joints to the carpal bones. When these muscles spasm, they pull the carpal bones forward and can collapse the carpal ridge like a bridge with too much weight in the middle. For this reason, these joints can automatically reset and make popping sounds when this muscle is released.
The symptoms of carpal tunnel syndrome and golfer's elbow (medial epicondylitis) are thought of as different problems, but they are truly different symptoms of a muscle spasm. Now, hopefully you know which muscle that is.
Wrist pain and Golfer's Elbow are caused by the same muscle spasm - the palmaris longs
Step 3
Why This Happens
The palmaris longus is a long tensile structure. When it enters spasm, it creates constant pull from the medial epicondyle into the palmar fascia.
At the elbow, this produces:
• traction at the medial epicondyle
• the pattern commonly called golfer’s elbow or medial epicondylitis
At the wrist and hand, it contributes to:
• increased tension in the palmar tissues
• reduced space and glide for neural structures
• compression patterns consistent with carpal tunnel syndrome
This is why both ends of the line must be understood together.
The logic is:
👉 palmaris longus in spasm
👉 medial pull at the elbow
👉 distal tension across the median nerve under the carpal flexor ligament
👉 median nerve irritation (carpal tunnel syndrome) and wrist compression
👉reduced nerve signalling across the impingement
When the muscle releases, both proximal and distal symptoms will be released and relieved.
Step 4
Anatomy
The palmaris longus originates at the medial epicondyle and travels centrally down the forearm into the palmar fascia.
Not everyone has a palmaris longus (missing in 10% to 20% of people), but when present it can usually be identified as a central tendon becoming visible with wrist flexion and finger approximation.
Its importance in this modality lies in its long, continuous pull:
• from the medial elbow
• through the central forearm
• into the palm
It sits superficially enough to assess, but its clinical effect can be much deeper than its appearance suggests.
Step 5
Palpation & Tissue Assessment
Palpation begins at the medial epicondyle and follows the central forearm toward the wrist.
Assess:
• the muscle belly proximally
• the long tendon centrally
• the tension into the palm distally
In spasm, the palmaris longus feels:
• narrow
• tense
• cord-like
• overly distinct
Healthy tissue feels:
• softer
• less sharply outlined
• less resistant to pressure
Cross-fiber palpation should be used at the muscle belly and tendon transition zones.
A useful assessment question is:
👉 does the forearm feel like a continuously tight cable from elbow to palm?
If so, the flexor chain is holding.
Step 6
Neurological Consequences
Because this pattern affects the central flexor forearm and palmar structures, it can influence nerve comfort and signaling through the wrist and hand.
This may present as:
• tingling
• numbness
• hand weakness
• nighttime symptoms
• altered grip endurance
Carpal Tunnel Syndrome and Golfer's elbow are caused by spasm of the palmaris longus. Spasm of the other carpal flexors make these problems worse. So, they also need to be released for this modality
When released:
• pain and inflammation of the medial elbow and carpal tunnel have no remaining cause and of course will immediatelbegin to go away
• wrist compression is eliminated
• hand comfort returns to normal
Step 7
Technique Demonstration
Because this pattern affects the central flexor forearm and palmar structures, it can influence nerve comfort and signaling through the wrist and hand.
This may present as:
• tingling
• numbness
• hand weakness
• nighttime symptoms
• altered grip endurance
The point is not that the palmaris longus alone explains every case of carpal tunnel, but that in your system it is often a major muscular driver of the compression pattern.
When released:
• tension at the medial elbow decreases
• wrist compression decreases
• hand comfort improves
Step 8
Worksheet Exercise
Download the skeletal worksheet and open it on your device.
Using a red pen tool, draw the palmaris longus from:
• the medial epicondyle
• down the central forearm
• into the palmar fascia
Add flank lines for:
• Origin
• Insertion
• Action
• Innervation
Indicate:
• where medial elbow pain is felt
• where wrist/hand compression symptoms are felt
Save and upload your completed worksheet.
Step 9
Practice Assignment
Clinical Skill Development
Practice this modality on a client. They should be laying supine with their forearm and hand in a suupine position.
You should be standing in a strong stance - legs slightly bent and facing your clients hand or facing the table.
Your goal is to:
• identify the palmaris longus if present
• assess tension from elbow to palm
• release the entire muscle until you no longer feel its fibers
Steps to release:
• cross-fiber palpation
• yang phase for at least 15 seconds after it is located. Sometimes much longer - in the yang phase one hand is stretching this muscle by flexing the wrist and the other hand is pressing into any of three of its pressure points
-
in the body close to the origin
-
in the body in the middle
-
in the palmar surface while stretching the wrist into extension
• proper wrist alignment is key to both these stretches and effective release
• Yin phase where you begin to hint that you are backing off your pressure. Make it feel like your pressure is beginning to withdraw, but don't give up any space. Doing these together will create the correct sensation that triggers the release. When Yin phase begins, the muscle begins to paolpadbly soften and lengthen. Almost immediately relief of stress on the wrist and elbow can be felt and visibly observed. This is release. Repeat this process until it completely releases and you have performed the technique correctly.
Do not treat only the elbow or only the wrist. Be sure both ends and all three points are palpably relaxed before you stop repeating the release process.
Treat the entire functional pattern!
Step 10:
Record Your Treatment
Record your session using a tripod.
Show:
• how you locate the medial epicondyle
• how you follow the palmaris line down the forearm
• hand and wrist support
• steady, specific pressure
• your Yang–Yin timing
The video should show that you understand the elbow-to-palm continuity of the pattern.
Step 12
Knowledge Check & Module Completion
Complete the quiz for this module.
You must understand:
• palmaris longus anatomy
• how it contributes to medial epicondylitis
• how it contributes to wrist and palmar compression
• correct technique principles
A score of 80% or higher is required to pass.
Once all components are completed, the module is finished.
1. Which muscle is emphasized as the root cause?
A. Flexor carpi ulnaris
B. Palmaris longus
C. Biceps
D. Triceps
2. Dysfunction can affect:
A. Only muscles
B. Organ positioning and pressure
C. Bone structure
D. Ligaments only
3. Why is this muscle significant in carpal tunnel patterns?
A. It increases strength
B. It contributes to fascial compression affecting the wrist tunnel
C. It stabilizes the elbow
D. It affects only the forearm
4. What is a key Releasology principle here?
A. Treat symptoms
B. Identify and release the specific muscle causing compression
C. Strengthen the area
D. Stretch globally
5. What is the expected result after release?
A. Increased pain
B. Relief of medial elbow and wrist symptoms
C. Weakness
D. Skin tightening