eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions

Lateral Epicondylitis: Differential Diagnoses & Workup

Author: Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Contributor Information and Disclosures

Updated: Jul 24, 2009

Differential Diagnoses

Cervical Disc Disease
Cervical Myofascial Pain
Cervical Radiculopathy
Cervical Spondylosis
Fibromyalgia
Medial Epicondylitis

Other Problems to Be Considered

Radial tunnel syndrome
Synovitis of the radiohumeral joint
Posterior interosseous nerve palsy
Neuralgic amyotrophy

Workup

Laboratory Studies

  • Laboratory studies generally are not indicated for the diagnosis of lateral epicondylitis.

Imaging Studies

  • Imaging studies usually are not necessary, but tendinopathies can be visualized with magnetic resonance imaging (MRI) and with ultrasonography.9

Other Tests

  • Electrodiagnostic studies may help to determine whether other causes of lateral elbow pain, such as cervical radiculopathy or posterior interosseous nerve palsy, are present.

Histologic Findings

Findings can include collagen disorientation, collagen disorganization, fiber separation by increased mucinoid substance, an increased prominence of cells and vascular spaces (with or without neovascularization), and focal necrosis or calcification. Superimposed evidence of a tear, including fibroblastic proliferation, hemorrhage, and organizing granulation tissue, may be revealed.

More on Lateral Epicondylitis

Overview: Lateral Epicondylitis
Differential Diagnoses & Workup: Lateral Epicondylitis
Treatment & Medication: Lateral Epicondylitis
Follow-up: Lateral Epicondylitis
References
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References

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  2. Sheon RP. Repetitive strain injury. 2. Diagnostic and treatment tips on six common problems. The Goff Group. Postgrad Med. Oct 1997;102(4):72-8, 81, 85 passim. [Medline].

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  9. Torp-Pedersen TE, Torp-Pedersen ST, Qvistgaard E, et al. Effect of glucocorticosteroid injections in tennis elbow verified on colour Doppler ultrasound: evidence of inflammation. Br J Sports Med. Mar 4 2008;[Medline].

  10. Altan L, Kanat E. Conservative treatment of lateral epicondylitis: comparison of two different orthotic devices. Clin Rheumatol. Mar 26 2008;[Medline].

  11. [Best Evidence] Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. Nov 4 2006;333(7575):939. [Medline]. [Full Text].

  12. Bisset L, Paungmali A, Vicenzino B, et al. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. Jul 2005;39(7):411-22; discussion 411-22. [Medline].

  13. [Best Evidence] Jafarian FS, Demneh ES, Tyson SF. The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis. J Orthop Sports Phys Ther. Jun 2009;39(6):484-9. [Medline].

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  25. Haake M, König IR, Decker T, et al. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg Am. Nov 2002;84-A(11):1982-91. [Medline].

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Further Reading

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Keywords

tennis elbow, lateral elbow tendinitis, lateral elbow tendonitis, elbow overuse syndrome

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Contributor Information and Disclosures

Author

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Daniel D Scott, MD, MA, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver and Health Sciences Center
Daniel D Scott, MD, MA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, National Multiple Sclerosis Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

 
 
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