Differential Diagnosis for Elbow Pain and Swelling
Single Most Likely Diagnosis
- Radial Head Fracture or Fracture of the Olecranon: Given the history of a fall and the presence of periarticular soft tissue swelling, subtle enthesopathy, and the specific involvement of areas around the elbow joint, a fracture is highly plausible. The absence of a visible posterior fat pad might suggest that it is not significantly displaced, but the presence of swelling and enthesopathy points towards a traumatic injury.
Other Likely Diagnoses
- Elbow Sprain or Ligamentous Injury: The swelling and enthesopathy around the medial and lateral humeral epicondyles could indicate a sprain or ligamentous injury, especially given the mechanism of injury (fall).
- Triceps Tendinopathy or Avulsion: The enthesopathy relative to the triceps mechanism engagement at the ulnar olecranon suggests an injury to the triceps tendon, which could be due to the fall.
- Medial or Lateral Epicondylitis: Although less likely given the acute onset post-fall, the enthesopathy around the epicondyles could also suggest epicondylitis, especially if there was pre-existing strain.
Do Not Miss Diagnoses
- Fracture with Neurovascular Compromise: It's crucial to assess for any signs of neurovascular compromise (e.g., numbness, tingling, decreased circulation) as this would necessitate urgent intervention.
- Infection (Septic Arthritis): Although less likely given the context of a recent fall, infection must always be considered in cases of joint swelling and pain, especially if there's a history of penetrating trauma or immune compromise.
- Olecranon Bursitis: Could be a consideration, especially if there's significant swelling over the olecranon, but the presence of enthesopathy and the mechanism of injury make traumatic causes more likely.
Rare Diagnoses
- Gout or Pseudogout: Acute onset of elbow pain and swelling could rarely be due to crystal arthropathies, especially in the absence of a clear traumatic cause.
- Hematoma or Soft Tissue Sarcoma: Very rare, but could be considered if the swelling does not resolve as expected or if there are atypical features on imaging.
- Osteochondritis Dissecans: A rare condition where a piece of cartilage and bone in a joint becomes damaged, potentially due to trauma, but more commonly seen in younger patients.