Differential Diagnosis (Soft Tissue)

Lateral epicondylosis

Lateral epicondylosis is also known as ‘tennis elbow’.

This condition often occurs as a result of overuse of the forearm extensor tendons.

Previously known as lateral epicondylitis, the pathological process is thought to be due to failed tendon healing and degeneration rather than acute inflammation.

The patient may complain of a diffuse ache located over the lateral aspect of the elbow. The diagnosis can be made clinically as illustrated previously – the image illustrates assessing for common extensor tendon insertion tenderness.

Learning bite

Lateral epicondylitis is often due to overuse of the forearm extensor tendons.

Medial epicondylosis

Medial epicondylosis is also known as ‘golfer’s elbow’.

This condition is seen less commonly than lateral epicondylosis and is similarly often caused by overuse, this time of the forearm flexor tendons, giving rise to pain over the medial aspect of the elbow.

In 20% of cases there may be associated ulnar nerve symptoms, specifically paraesthesia in an ulnar nerve distribution [5]. The diagnosis should again be made clinically.

Learning bite

Medial epicondylosis is often due to overuse of the forearm flexor tendons.

Olecranon bursitis

Olecranon bursitis is usually the result of direct trauma (such as a fall onto the outstretched elbow) or repetitive friction. It may be acute or chronic and can be associated with crystal arthropathy or inflammatory arthritis. Septic bursitis is most commonly due to Staphylococcus aureus infection and can arise directly from an overlying skin wound.

On examination there is localised swelling, tenderness and possible erythema over the posterior aspect of the elbow. Patients with septic bursitis may be systemically unwell with pyrexia, cellulitis and axillary lymphadenopathy.

Blood tests may reveal an elevated ESR, CRP and white cell count. Septic or crystal-induced bursitis can be confirmed with bursal aspiration and subsequent microscopy and Gram stain.

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