Differential Diagnosis for Bursitis vs Lateral Epicondylitis

When attempting to differentiate between bursitis and lateral epicondylitis, it's crucial to consider the clinical presentation, history, and physical examination findings. Here's a structured approach to the differential diagnosis:

• Single Most Likely Diagnosis

  • Lateral epicondylitis: This condition, also known as tennis elbow, is characterized by pain and tenderness on the lateral aspect of the elbow, often related to overuse or repetitive strain of the forearm extensors. It's a common condition that can mimic bursitis in terms of location but is distinguished by its specific involvement of the tendinous insertions.

• Other Likely Diagnoses

  • Olecranon bursitis: This condition involves inflammation of the bursa at the back of the elbow, leading to swelling and pain. While it's more commonly associated with direct trauma or repetitive pressure on the elbow, it can sometimes be confused with lateral epicondylitis due to overlapping symptoms.
  • Medial epicondylitis: Known as golfer's elbow, this condition affects the medial aspect of the elbow and is caused by strain on the forearm flexors. Although it's on the opposite side of the elbow from lateral epicondylitis, it's another common elbow condition that could be considered in the differential diagnosis.

• Do Not Miss Diagnoses

  • Radial head fracture: A fracture of the radial head can present with lateral elbow pain and should be considered, especially if there's a history of trauma. Missing this diagnosis could lead to improper healing and chronic issues.
  • Osteochondritis dissecans of the capitellum: This condition involves a fragment of cartilage and bone becoming detached from the capitellum, often due to repetitive stress. It's more common in young athletes and can present with lateral elbow pain, making it a critical diagnosis not to miss.
  • Infection (septic bursitis or osteomyelitis): While less common, infections in the elbow region can present with pain, swelling, and redness, similar to bursitis or lateral epicondylitis. Missing an infectious cause could lead to severe consequences, including joint destruction or systemic infection.

• Rare Diagnoses

  • Rheumatoid arthritis or other autoimmune conditions: These can cause elbow pain and swelling but are less common causes of lateral elbow pain compared to bursitis or lateral epicondylitis.
  • Tumors (benign or malignant): Tumors around the elbow, such as a ganglion cyst or a more serious malignant tumor, are rare but could present with localized pain and swelling, mimicking other conditions.