How can I differentiate between lateral epicondylitis and other causes of lateral elbow pain during a clinical assessment?

To differentiate between lateral epicondylitis and other causes of lateral elbow pain during a clinical assessment, first consider the typical presentation of lateral epicondylitis. Lateral epicondylitis, also known as tennis elbow, usually presents with pain on the lateral aspect of the elbow ¹. This pain is often aggravated by activities that involve high force, hand-gripping or pinching, or the use of high-amplitude vibrating handheld tools ¹.

If there is no response to initial treatment for suspected lateral epicondylitis after 6 weeks, it is important to reassess the person and consider alternative diagnoses ¹. Referral to an orthopaedic surgeon should be considered if the diagnosis is uncertain, or if symptoms persist despite 6 to 12 months of optimal management in primary care ¹. Imaging techniques, such as ultrasonography or magnetic resonance imaging (MRI), may be used to confirm the diagnosis when it is uncertain ¹.

Other conditions that may present with elbow pain or related symptoms include:

• Spondyloarthritis: Enthesitis, which is inflammation where tendons or ligaments insert into bone, can occur without an apparent mechanical cause ². If enthesitis is persistent, in multiple sites, or accompanied by other features such as back pain without apparent mechanical cause, current or past uveitis, psoriasis, gastrointestinal or genitourinary infection, inflammatory bowel disease, or a first-degree relative with spondyloarthritis or psoriasis, referral to a rheumatologist for a spondyloarthritis assessment should be considered ².
• Lyme disease: This condition can cause migratory joint or muscle aches and pain, or inflammatory arthritis affecting one or more joints, which may be fluctuating and migratory ³. Other symptoms that might suggest Lyme disease include fever, sweats, swollen glands, malaise, fatigue, neck pain or stiffness, cognitive impairment, headache, or paraesthesia ³. Neurological symptoms like facial palsy, other unexplained cranial nerve palsies, meningitis, mononeuritis multiplex, or other unexplained radiculopathy are also possible ³. When assessing for Lyme disease, explore the duration of symptoms and any history of possible tick exposure, although a clear history of tick exposure is not always present ³.