Differential Diagnosis for Chronic Pain above the Elbow
The patient's complaint of chronic pain in the area above the elbow, which occurs with arm extension and arm lifting and starts anterior to the elbow before moving medially and proximally, suggests a variety of potential diagnoses. These can be categorized as follows:
Single Most Likely Diagnosis
- Medial Epicondylitis (Golfer's Elbow): This condition is characterized by pain on the medial (inner) aspect of the elbow, which can radiate proximally. It is often associated with activities that involve flexion of the wrist and rotation of the forearm, but pain can also be exacerbated by lifting and extension of the arm, fitting the patient's symptoms.
Other Likely Diagnoses
- Bicipital Tendinitis: Inflammation of the biceps tendon can cause pain in the anterior aspect of the elbow, which may radiate proximally. Activities that involve lifting and arm extension can exacerbate this condition.
- Ulnar Nerve Entrapment: This condition can cause pain, numbness, and tingling in the medial aspect of the elbow, forearm, and hand. Symptoms can be worsened by activities that involve flexion or extension of the elbow.
- Strain of the Brachialis Muscle: The brachialis muscle is involved in elbow flexion, and strain can cause pain in the anterior aspect of the elbow, potentially radiating proximally.
Do Not Miss Diagnoses
- Cervical Radiculopathy: Although less likely, pain referred from the cervical spine (e.g., C6 or C7 radiculopathy) can present as arm pain and should not be missed due to the potential for serious underlying conditions such as disc herniation or spinal stenosis.
- Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It can cause pain in the arm, shoulder, and chest, and while less common, it's critical not to overlook it.
Rare Diagnoses
- Osteochondritis Dissecans of the Humeral Condyle: A rare condition where a piece of cartilage and bone in the elbow joint becomes damaged, leading to pain and potentially locking or catching sensations in the elbow.
- Tumors (e.g., Osteoid Osteoma, Osteosarcoma): Although extremely rare, tumors of the bone or soft tissues around the elbow can cause chronic pain and should be considered in the differential diagnosis, especially if the pain is persistent, worsening, or accompanied by other systemic symptoms.