Differential Diagnosis

• Single most likely diagnosis
  • Lateral and Medial Epicondylitis (Tennis Elbow and Golfer's Elbow): This condition is characterized by pain on the outer (lateral) or inner (medial) aspect of the elbow, which can radiate down to the forearm and wrist. The symptoms worsen with activities that involve gripping or twisting, such as squeezing or picking up objects, which aligns with the patient's experience. The partial relief from wrist braces and dry needling also supports this diagnosis.
• Other Likely diagnoses
  • Tendinosis: A condition similar to tendonitis but without inflammation, characterized by chronic pain and degeneration of the tendons. The lack of response to the cortisone injection could suggest tendinosis rather than tendonitis.
  • Thoracic Outlet Syndrome (TOS): 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). Symptoms can include pain in the shoulders, arms, and hands, which could explain the patient's forearm and upper arm pain.
  • Repetitive Strain Injury (RSI): A condition caused by repetitive activities, leading to pain and inflammation in the muscles, tendons, and nerves of the affected area. The worsening of symptoms towards the end of the workday suggests a possible RSI.
• Do Not Miss diagnoses
  • Cervical Radiculopathy: This condition involves nerve root compression in the cervical spine, leading to pain, numbness, and weakness in the arm. Although less likely, missing this diagnosis could lead to significant morbidity if not addressed.
  • Cubital Tunnel Syndrome: Involves compression of the ulnar nerve at the elbow, causing pain, numbness, and weakness in the hand and arm. Given the potential for severe and lasting damage, this diagnosis should not be overlooked.
• Rare diagnoses
  • Amyotrophic Lateral Sclerosis (ALS): A progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. While extremely rare and unlikely, ALS could present with muscle weakness and pain, making it a diagnosis that, although rare, should be considered to avoid a potentially devastating missed diagnosis.
  • Peripheral Artery Disease (PAD): A condition where narrowed arteries reduce blood flow to the limbs. Although more commonly associated with leg pain, PAD could potentially cause arm pain, especially if the condition is advanced or if there are specific risk factors present.