Elbow Tendinitis: Symptoms and Differential Diagnoses

Clinical Presentation

The American Academy of Family Physicians recommends that elbow tendinitis is typically characterized by localized pain of insidious onset, related to activity, and worsened by repetitive movements, with well-localized tenderness to palpation of the epicondyles 1
The American Academy of Family Physicians notes that the pain is often described as progressive, initially present during activity but may decrease after warming up 1
The American Academy of Family Physicians states that the pain can gradually worsen, with pain at rest in advanced stages 1
The American Academy of Family Physicians reports that the condition often starts insidiously, coinciding with new or increased activity, and is more common in the dominant arm 1, 2, 3
The American Academy of Family Physicians indicates that lateral epicondylitis is 7 to 10 times more frequent than medial epicondylitis, affecting the dominant arm in 75% of cases 2, 3
The American Academy of Family Physicians suggests that the typical age of onset is after 40 years, with both men and women equally affected 2, 3

The American College of Radiology recommends that radiographs are always the first-line imaging modality to exclude osseous pathologies, loose bodies, and calcifications 4, 6
The American College of Radiology notes that comparison with the contralateral side is useful to identify asymmetries 4, 6
The American College of Radiology states that MRI without contrast is recommended if radiographs are normal but symptoms persist after 6-12 weeks of conservative treatment 6
The American College of Radiology reports that ultrasound is an alternative to MRI for evaluating tendons and ligaments, with a sensitivity of 64.52% and specificity of 85.19% for tears of the common extensor tendon 7, 8

The American Academy of Family Physicians recommends considering fractures, loose bodies, osteochondral lesions, degenerative arthritis, and heterotopic ossification in the differential diagnosis of elbow tendinitis 1, 4, 6
The American College of Radiology notes that ulnar collateral ligament injuries should be considered, particularly in athletes who participate in repetitive throwing activities 7, 8
The American Academy of Family Physicians suggests that nerve compression syndromes, such as cubital tunnel syndrome and radial tunnel syndrome, should be considered in the differential diagnosis 4, 9, 10

The American Academy of Family Physicians warns against ignoring the presence of multiple symptomatic tendons, which should prompt a rheumatologic evaluation 1
The American Academy of Family Physicians notes that intra-articular pathology, such as joint effusion, is rare in pure tendinopathy 1
The American Academy of Family Physicians recommends recognizing that most cases are degenerative (tendinosis) rather than inflammatory at the time of consultation 1