Differential Diagnosis

The patient presents with two distinct complaints: a swollen, painful gum on the left lower jaw and left elbow pain. The differential diagnoses for these complaints can be categorized as follows:

• Single Most Likely Diagnosis
  • Dental abscess for the gum complaint: The presence of swelling, redness, and pain around the second to last molar, along with observed cavities in the last molar, strongly suggests a dental abscess.
  • Lateral epicondylitis for the elbow complaint: The tenderness on palpation of the lateral epicondyle, pain on resisted wrist extension, and the absence of swelling, redness, or deformity are classic findings for lateral epicondylitis, especially in the context of repetitive tasks as a plumber.
• Other Likely Diagnoses
  • Periodontal disease for the gum complaint: Given the patient's history of smoking and the presence of cavities, periodontal disease could be a contributing factor to the gum symptoms.
  • Medial epicondylitis or olecranon bursitis for the elbow complaint: Although the examination points more towards lateral epicondylitis, medial epicondylitis (golfer's elbow) and olecranon bursitis could be considered if the symptoms or examination findings were slightly different.
• Do Not Miss Diagnoses
  • Osteomyelitis of the jaw: Although less likely, osteomyelitis could present with similar symptoms to a dental abscess and is a serious condition that requires prompt treatment.
  • Radial head fracture or other elbow fractures: In the absence of a clear history of trauma, these might seem less likely, but they are important to consider, especially if the patient's symptoms worsen or do not respond to initial treatment for lateral epicondylitis.
• Rare Diagnoses
  • Neoplastic conditions (e.g., squamous cell carcinoma of the gum or a bone tumor in the elbow): These are less common but should be considered if the patient's symptoms do not improve with standard treatment or if there are atypical findings on examination or imaging.
  • Inflammatory arthropathies (e.g., rheumatoid arthritis, psoriatic arthritis) affecting the elbow: While these conditions can cause elbow pain, they typically present with a more systemic symptom complex and involvement of multiple joints.