Tennis elbow, formally known as lateral epicondylitis, is a common condition characterized by pain on the outer side of the elbow. However, its symptoms can closely resemble those of several other conditions, making accurate identification important for effective management. This article explores various conditions that can cause similar elbow pain and are frequently mistaken for tennis elbow.
Understanding Tennis Elbow
Tennis elbow is an overuse injury affecting the tendons that connect the forearm muscles to the outside of the elbow, specifically the extensor carpi radialis brevis (ECRB) tendon, which are responsible for extending the wrist backward and straightening the fingers. Repetitive motions, such as gripping, lifting, or wrist extension, can lead to microscopic tears or degeneration.
Typical symptoms include pain or tenderness directly over the bony prominence on the outer part of the elbow, which may radiate down the forearm. Individuals often experience a weakened grip and increased pain when performing activities like lifting objects or shaking hands. While commonly associated with racquet sports, it can result from various occupational or daily activities involving repetitive arm movements.
Conditions with Similar Symptoms
Several conditions can present with symptoms that overlap with tennis elbow, leading to potential misdiagnosis. Understanding these distinctions is important for proper treatment.
Golfer’s elbow
Golfer’s elbow, or medial epicondylitis, is a condition similar to tennis elbow but affects the tendons on the inner side of the elbow. These tendons, primarily the flexor tendons, are involved in bending the wrist forward and closing the fingers into a fist. While its location is different, the pain can also radiate into the forearm, mimicking the diffuse discomfort of tennis elbow.
Radial tunnel syndrome (RTS)
Radial tunnel syndrome (RTS) involves the compression or entrapment of the radial nerve, which runs near the elbow and down the forearm. This condition can cause deep, aching pain in the forearm and sometimes around the outer elbow, making it difficult to differentiate from tennis elbow. Unlike tennis elbow, RTS typically does not involve tenderness directly on the lateral epicondyle, and it may cause weakness in the forearm muscles without actual tendon damage.
Cervical radiculopathy
Cervical radiculopathy occurs when a nerve in the neck, particularly at the C6 or C7 level, becomes pinched or irritated. This irritation can cause referred pain, numbness, or tingling that travels down the arm to the elbow and forearm. Since the pain can manifest around the elbow region, it can be mistaken for a local elbow issue like tennis elbow, even though the source of the problem is in the cervical spine.
Elbow osteoarthritis
Elbow osteoarthritis involves the degeneration of cartilage within the elbow joint, leading to bone-on-bone friction. This wear-and-tear condition typically causes pain, stiffness, and a reduced range of motion in the elbow. Although less common in the elbow compared to other joints, if osteoarthritis affects the joint surfaces near the lateral epicondyle, its pain and stiffness can be confused with the tendon pain characteristic of tennis elbow.
Distinguishing Features and Diagnosis
Healthcare professionals employ various methods to differentiate tennis elbow from conditions with similar symptoms. A thorough assessment begins with evaluating symptom patterns, noting the exact location of pain, and identifying movements that worsen or alleviate it. For instance, radial tunnel syndrome might present with deeper forearm pain that is less localized to the epicondyle, while cervical radiculopathy may include additional neurological symptoms like numbness or tingling radiating from the neck.
Physical examination involves palpation around the elbow and forearm to pinpoint tenderness. Doctors perform specific resisted movements, such as wrist extension for tennis elbow or wrist flexion for golfer’s elbow, to reproduce the pain. Checking neck range of motion and neurological reflexes identify if the pain originates from the cervical spine.
In some cases, imaging studies or nerve tests confirm a diagnosis or rule out other conditions. X-rays assess for arthritis or bone abnormalities, while magnetic resonance imaging (MRI) provides detailed views of soft tissues like tendons, ligaments, and nerves. Nerve conduction studies evaluate nerve function and identify nerve entrapments, such as radial tunnel syndrome.
Seeking Professional Help
Given the array of conditions that can mimic tennis elbow, obtaining an accurate diagnosis is important for effective treatment. If elbow pain persists, worsens, or interferes with daily activities, seeking professional medical advice is advisable. It is important to consult a healthcare provider if new symptoms like numbness, tingling, or weakness develop, as these may indicate a nerve-related issue. A doctor, physical therapist, or other qualified healthcare professional can determine the precise cause of the pain. This diagnosis is important for developing an appropriate treatment plan.