Blonna Davide, Hoxha Norsaga, Greco Valentina, Rivoira Carolina, Bonasia Davide Edoardo, Rossi Roberto
Department of Orthopedics and Traumatology, Mauriziano Umberto I Hospital, Turin, Italy.
University Hospital of Turin, Turin, Italy.
Am J Sports Med. 2025 Apr;53(5):1195-1201. doi: 10.1177/03635465251319545. Epub 2025 Feb 24.
Lateral elbow pain, often attributed to lateral epicondylitis, presents diagnostic complexities. Lateral epicondylitis, or tennis elbow, is the most frequent cause of lateral elbow pain, but a differential diagnosis among all the potential causes of lateral elbow pain is not easy.
To evaluate the rate of misdiagnoses in patients previously diagnosed with lateral epicondylitis, identify at-risk patient profiles, and determine sensitive clinical tests for a misdiagnosis.
Case series; Level of evidence, 4.
A prospective analysis was conducted on 189 consecutive patients with a previous diagnosis of lateral epicondylitis and failed nonoperative treatment. According to medical history and a physical examination, patients were preliminarily classified into the typical or atypical lateral epicondylitis group. Atypical epicondylitis was defined as one of the following: atypical lateral pain location, history of trauma, limited range of motion (ROM), elbow swelling, negative Cozen test finding, and physical examination findings suggesting a misdiagnosis. Patients in the atypical group were further investigated for a potential lateral epicondylitis misdiagnosis using magnetic resonance imaging, computed tomography, and/or analysis of intraoperative samples according to suspected underlying abnormalities. Univariate and logistic regression analyses were conducted to assess the risk of a misdiagnosis. A standardized diagnostic analysis was performed to evaluate the clinical tests used during the physical examination to identify misdiagnosed patients.
A misdiagnosis occurred in 21 of 189 (11%) patients. The most common misdiagnoses were posterolateral elbow instability in 6 patients; radial nerve compression and inflammatory osteoarthritis in 3 patients each; and osteochondritis dissecans, posterolateral plica, and primary osteoarthritis in 2 patients each. The variables associated with a misdiagnosis were young age (≤30 years; odds ratio [OR], 66.90; < .001), history of trauma (OR, 17.85; = .0027), history of a limitation of ROM and/or mechanical symptoms (OR, 16.68; = .0278), history of elbow swelling (OR, 14.32; = .0032), and number of corticosteroid injections (OR, 2.00; = .0007). Atypical lateral pain location highly predicted a misdiagnosis, with a sensitivity of 90.5%.
A misdiagnosis can occur in patients affected by longstanding lateral elbow pain. Young patients and patients with a history of elbow trauma, a limitation of ROM, swelling, corticosteroid injections, and atypical lateral pain should be highly suspected for a misdiagnosis.
外侧肘部疼痛常被归因于外侧上髁炎，其诊断存在复杂性。外侧上髁炎，即网球肘，是外侧肘部疼痛最常见的原因，但对所有外侧肘部疼痛潜在病因进行鉴别诊断并非易事。
评估先前被诊断为外侧上髁炎患者的误诊率，确定高危患者特征，并确定用于误诊的敏感临床检查。
病例系列；证据等级，4级。
对189例先前诊断为外侧上髁炎且非手术治疗失败的连续患者进行前瞻性分析。根据病史和体格检查，患者初步分为典型或非典型外侧上髁炎组。非典型上髁炎定义为以下情况之一：外侧疼痛位置不典型、有创伤史、活动范围（ROM）受限、肘部肿胀、科曾试验结果阴性以及体格检查结果提示误诊。根据疑似潜在异常情况，对非典型组患者进一步使用磁共振成像、计算机断层扫描和/或术中样本分析进行外侧上髁炎潜在误诊调查。进行单因素和逻辑回归分析以评估误诊风险。进行标准化诊断分析以评估体格检查期间用于识别误诊患者的临床检查。
189例患者中有21例（11%）发生误诊。最常见的误诊情况为：6例为肘后外侧不稳定；3例为桡神经受压和炎性骨关节炎；2例为剥脱性骨软骨炎、后外侧皱襞和原发性骨关节炎。与误诊相关的变量为年轻（≤30岁；比值比[OR]，66.90；P <.001）、有创伤史（OR，17.85；P =.0027）、有ROM受限和/或机械性症状史（OR，16.68；P =.0278）、有肘部肿胀史（OR，14.32；P =.0032）以及皮质类固醇注射次数（OR，2.00；P =.0007）。外侧疼痛位置不典型高度预测误诊，敏感性为90.5%。
长期外侧肘部疼痛患者可能发生误诊。年轻患者以及有肘部创伤史、ROM受限、肿胀、皮质类固醇注射史和外侧疼痛位置不典型的患者应高度怀疑误诊。
