Clinical diagnosis of lateral-sided elbow pain: predictors for recognizing a diagnosis other than tennis elbow.

BACKGROUND

Lateral elbow pain (LEP) is most commonly caused by lateral elbow tendinopathy (LET), a diagnosis typically made based on clinical symptoms and physical examination, without the need for additional diagnostic imaging in the initial workup. However, recent research suggests that at least 11% of LEP cases are misdiagnosed as LET. Several other conditions can mimic LET, making awareness of the full differential diagnosis essential to ensure accurate diagnosis and initiate the appropriate treatment. This study aims to identify factors of patient characteristics, history taking, and physical examination that aid clinicians in distinguishing LET from other causes of LEP.

METHODS

A prospective cohort of 170 consecutive patients with LEP presenting in the outpatient orthopedic clinic of 3 large teaching hospitals were included. All patients were assessed using a standardized diagnostic protocol. Bivariable analysis and multivariable binary logistic regression with a stepwise backward selection procedure were performed to identify variables associated with a diagnosis other than LET.

RESULTS

In this cohort, 46.5% of the patients received a diagnosis other than LET. Independent predictors of an alternative diagnosis included age ≤30 years (P < .001), acute symptom onset (P = .045), joint locking (P < .001), presence of joint effusion (hydrops) (P < .001), a positive instability test (P = .013), and a negative Maudsley test (P < .001).

CONCLUSION

Nearly half of patients presenting with lateral elbow pain are diagnosed with conditions other than LET. The identification of age ≤30 (P < .001), acute onset (P = .045), locking (P < .001), hydrops (P < .001), any positive instability test (P = .013), and a negative Maudsley test (P < .001) as independent predictors for a diagnosis other than LET has practical implications. Recognizing these factors enables clinicians to consider alternative diagnoses, potentially preventing misdiagnosis and treatment delay.