Elbow
Lateral elbow pain - differential diagnosis
Differential diagnosis of lateral elbow pain including tendon, plica, radial head and nerve causes
7 questions
1 source pages
1 images
1 fact-check flags
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Q1List the differential diagnosis of lateral elbow pain.📷▸
- Tennis elbow (lateral epicondylitis)
- Radial tunnel syndrome (4-5cm distal to lateral epicondyle)
- Plica syndrome (most common is posterolateral fold)
- RCJ arthritis, OCD of lateral condyle, PLRI
Q2What is lateral epicondylitis and its pathophysiology?▸
- Overuse injury with eccentric overload at origin of common extensor tendon
- Tendinosis and inflammation at origin of ECRB
- Concomitant radial tunnel syndrome in 5%
- Patho: angiofibroblastic hyperplasia + disorganized collagen
Q3Which muscles originate from the lateral epicondyle and supracondylar ridge?▸
- ECRB, ED, EDM, ECU and anconeus all originate from the lateral epicondyle
- ECRL and brachioradialis arise from the supracondylar ridge
Q4What are the symptoms and signs of lateral epicondylitis?▸
- Sx: lateral elbow pain, weak grip, pain on resisted wrist extension
- PE: tenderness over lateral epicondyle
- Pain on resisted wrist/MF extension with elbow extended; pain on wrist flexion
- Imaging to rule out other causes
Q5Describe the non-operative management of lateral epicondylitis.▸
- 95% effective; lifestyle modification, physio, NSAID, steroid (<20mg steroid)
- Counterforce brace (5cm wide non elastic support distal to elbow, does not allow full muscle expansion, thereby decreased stretch on lateral epicondyle)
- BMJ Bisset 2006: steroids better effects at 6 weeks but with high recurrence rate, poorer outcomes c/w physio in the long term
- PRP: 2020 meta-analysis favoured PRP long term, steroid best short term; Cochrane 2021 does not support PRP
Q6When is surgery indicated in lateral epicondylitis and what are the results?▸
- After failed 9-12 months of non-operative management
- Release and debridement of ECRB origin (open/arthroscopic/percutaneous equivalent)
- Results: 85% complete relief, 5% no benefit, 10% some improvement
Q7What is plica syndrome of the elbow?▸
- Part of the ddx of lateral elbow pain
- Normally 4 folds: anterior, posterior, posterolateral, lateral
- Most common symptomatic plica is the posterolateral fold
Fact check
PRP has no evidence for lateral epicondylitis (2021 Cochrane does not support it) — contested/oversimplified — Cochrane 2021: PRP or autologous blood probably gives no clinically significant benefit vs placebo at 3 months, but Hohmann 2023 found PRP superior to steroid at 3-6 months; steroid benefit is short term. — (medium confidence) — source