eMedicine Specialties > Sports Medicine > Upper Limb

Lateral Epicondylitis: Differential Diagnoses & Workup

Author: Bryant James Walrod, MD, Fellow in Primary Care Sports Medicine, Medical College of Wisconsin
Coauthor(s): Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Contributor Information and Disclosures

Updated: Jul 23, 2009

Differential Diagnoses

Cervical Radiculopathy
Elbow and Forearm Overuse Injuries
Little League Elbow Syndrome
Medial Epicondylitis

Other Problems to Be Considered

Humeral fracture
Loose body
Osteoarthritis
Osteochondritis dissecans (OCD) of the capitellum
Stress fracture

Workup

Laboratory Studies

  • Laboratory studies are typically not useful in the workup of lateral epicondylitis.

Imaging Studies

  • Imaging studies are rarely needed in the initial workup of lateral elbow pain.
  • Consider pain film radiologic evaluation if the patient's symptoms persist despite adequate treatment or to evaluate for osteophytes, degenerative joint disease, or OCD
  • Plain films may reveal calcification along the lateral epicondyle.
  • Consider magnetic resonance imaging (MRI), bone scanning, and/or computed tomography (CT) scanning to evaluate for OCD or stress fractures.

Other Tests

  • A local anesthetic block may lead to symptom resolution and confirmation of the diagnosis.

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

  1. Alfredson H, Ohberg L, Forsgren S. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc. Sep 2003;11(5):334-8. [Medline].

  2. Wilson JJ, Best TM. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician. Sep 1 2005;72(5):811-8. [Medline]. [Full Text].

  3. Calfee RP, Patel A, DaSilva MF, Akelman E. Management of lateral epicondylitis: current concepts. J Am Acad Orthop Surg. Jan 2008;16(1):19-29. [Medline].

  4. Bell S. Elbow and arm pain. In: Brukner P, Kahn K, eds. Clinical Sports Medicine. 3rd ed. New South Wales, Australia: McGraw-Hill; 2006:293.

  5. Smidt N, van der Windt DA, Assendelft WJ, et al. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. Feb 23 2002;359(9307):657-62. [Medline].

  6. Green S, Buchbinder R, Barnsley L, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2002;CD003686. [Medline].

  7. Assendelft W, Green S, Buchbinder R, Struijs P, Smidt N. Tennis elbow. Clin Evid. Jun 2004;1633-44. [Medline].

  8. Struijs PA, Smidt N, Arola H, et al. Orthotic devices for the treatment of tennis elbow. Cochrane Database Syst Rev. 2002;CD001821. [Medline].

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

  10. Borkholder CD, Hill VA, Fess EE. The efficacy of splinting for lateral epicondylitis: a systematic review. J Hand Ther. Apr-Jun 2004;17(2):181-99. [Medline].

  11. Bisset L, Paungmali A, Vicenzino B, Beller E. 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].

  12. [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].

  13. [Best Evidence] Buchbinder R, Green SE, Youd JM, et al. Shock wave therapy for lateral elbow pain. Cochrane Database Syst Rev. Oct 19 2005;CD003524. [Medline].

  14. Smidt N, Assendelft WJ, Arola H, et al. Effectiveness of physiotherapy for lateral epicondylitis: a systematic review. Ann Med. 2003;35(1):51-62. [Medline].

  15. Ramsay DJ, Bowman MA, Greenman, PE, et al, for the NIH Consensus Panel. NIH Consensus Conference. Acupuncture. JAMA. Nov 4 1998;280(17):1518-24. [Medline].

  16. Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg [Am]. Mar 2003;28(2):272-8. [Medline].

  17. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. Nov 2006;34(11):1774-8. [Medline].

  18. [Best Evidence] Wong SM, Hui AC, Tong PY, et al. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. Dec 6 2005;143(11):793-7. [Medline]. [Full Text].

  19. [Best Evidence] Placzek R, Drescher W, Deuretzbacher G, Hempfing A, Meiss AL. Treatment of chronic radial epicondylitis with botulinum toxin A. A double-blind, placebo-controlled, randomized multicenter study. J Bone Joint Surg Am. Feb 2007;89(2):255-60. [Medline].

  20. [Best Evidence] Hayton MJ, Santini AJ, Hughes PJ, et al. Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study. J Bone Joint Surg Am. Mar 2005;87(3):503-7. [Medline].

  21. Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med. Nov-Dec 2003;31(6):915-20. [Medline].

  22. Zeisig E, Fahlström M, Ohberg L, Alfredson H. Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study. Br J Sports Med. Apr 2008;42(4):267-71. [Medline].

  23. Brosseau L, Casimiro L, Milne S, et al. Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev. 2002;CD003528. [Medline].

  24. Baker CL Jr, Baker CL 3rd. Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med. Feb 2008;36(2):254-60. [Medline].

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Further Reading

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Keywords

tennis elbow, lateral elbow stress syndrome, wrist extensor tendonitis, lateral elbow overuse syndrome, elbow and forearm overuse injuries, coffee cup sign, coffee-cup sign

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Contributor Information and Disclosures

Author

Bryant James Walrod, MD, Fellow in Primary Care Sports Medicine, Medical College of Wisconsin
Disclosure: Nothing to disclose.

Coauthor(s)

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Andrew D Perron, MD, Residency Director, Department of Emergency Medicine, Maine Medical Center
Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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