03/15/2026
Quand une épicondylite n'en est pas une...
𝗪𝗵𝗲𝗻 "𝗧𝗲𝗻𝗻𝗶𝘀 𝗘𝗹𝗯𝗼𝘄" 𝗜𝘀𝗻'𝘁 𝗧𝗲𝗻𝗻𝗶𝘀 𝗘𝗹𝗯𝗼𝘄: 𝗨𝗻𝗰𝗼𝘃𝗲𝗿𝗶𝗻𝗴 𝘁𝗵𝗲 𝗠𝗶𝘀𝗱𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀 𝗼𝗳 𝗟𝗮𝘁𝗲𝗿𝗮𝗹 𝗘𝗹𝗯𝗼𝘄 𝗣𝗮𝗶𝗻
⬛ Lateral elbow pain is overwhelmingly attributed to lateral epicondylitis, commonly known as tennis elbow.
⬛ While it affects 1% to 3% of the adult population annually, diagnosing the root cause of the pain is not always straightforward.
⬛ A 2025 study by Blonna et al., titled "When Lateral Epicondylitis Is Not Lateral Epicondylitis," sheds light on how often and why misdiagnoses occur, especially when patients fail to improve with standard nonoperative treatments.
⬛ Here is a thorough breakdown of the study's findings, the most common underlying conditions, and the "red flags" that clinicians and patients should watch out for.
𝗧𝗵𝗲 𝗦𝗰𝗼𝗽𝗲 𝗼𝗳 𝘁𝗵𝗲 𝗣𝗿𝗼𝗯𝗹𝗲𝗺 📊
⬛ The researchers evaluated 189 patients who had been previously diagnosed with lateral epicondylitis, suffered from symptoms for at least 6 months, and had experienced partial or complete failure of nonoperative treatments.
⬛ The study found that 11% (21 out of 189) of these patients were completely misdiagnosed.
⬛ Instead of tennis elbow, these patients were actually suffering from an array of different conditions that require entirely different treatments.
⬛ The most common actual diagnoses among the misdiagnosed group were:
⬛ Posterolateral elbow instability (29% of misdiagnoses).
⬛ Posterior interosseous nerve (PIN) compression or irritation (14%).
⬛ Inflammatory osteoarthritis, such as rheumatoid arthritis or psoriasis (14%).
⬛ Osteochondritis dissecans (10%).
⬛ Posterolateral plica (10%).
⬛ Primary osteoarthritis (10%).
𝗥𝗲𝗱 𝗙𝗹𝗮𝗴𝘀: 𝗪𝗵𝗼 𝗶𝘀 𝗮𝘁 𝗥𝗶𝘀𝗸 𝗳𝗼𝗿 𝗮 𝗠𝗶𝘀𝗱𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀? 🚩
⬛ The study identified several distinct patient profiles and historical factors that strongly suggest a diagnosis other than lateral epicondylitis.
⬛ Young Age: This was a massive indicator.
⬛ The study suggests that lateral elbow pain in young patients should be considered non-lateral epicondylitis until proven otherwise.
⬛ All patients under the age of 20, and the majority of those aged 21 to 30, had a final diagnosis other than tennis elbow.
⬛ Patients aged 30 and younger had a significantly higher misdiagnosis risk.
⬛ History of Trauma: Patients who had previously suffered elbow trauma had a highly elevated risk of misdiagnosis.
⬛ This history strongly points to issues like posttraumatic osteoarthritis or posterolateral instability.
⬛ Swelling, Mechanical Symptoms, and Limited Mobility: Typical tennis elbow does not usually restrict the joint.
⬛ A history of elbow swelling, limited range of motion (ROM), or mechanical symptoms like clicking, snapping, or locking are major red flags.
⬛ Multiple Corticosteroid Injections: A high number of previous corticosteroid injections was linked to misdiagnosis.
⬛ Interestingly, in cases of non-traumatic posterolateral elbow instability, patients had received a median of 5 injections, suggesting the repeated injections may have caused iatrogenic damage to the lateral collateral ligament.
𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗘𝘃𝗮𝗹𝘂𝗮𝘁𝗶𝗼𝗻: 𝗙𝗶𝗻𝗱𝗶𝗻𝗴 𝘁𝗵𝗲 𝗧𝗿𝘂𝗲 𝗖𝗮𝘂𝘀𝗲 🔍
⬛ To avoid months of frustrating and ineffective treatments, the study highlights key physical examination screening tests.
⬛ Atypical Pain Location: This was the most sensitive clinical indicator.
⬛ If a patient’s pain was not primarily located at the typical anterolateral aspect of the lateral epicondyle, it highly predicted a misdiagnosis with a sensitivity of 90.5%.
⬛ For instance, pain located 3 to 4 cm distal to the epicondyle often indicated PIN compression.
⬛ The Cozen Test: A negative Cozen test (where extending the wrist against resistance does not produce lateral elbow pain) had a 61.9% sensitivity for indicating a misdiagnosis.
⬛ A Novel Finding - Anconeus Fasciculations: During the posterolateral drawer test, researchers noted a visible, involuntary twitching (fasciculation) of the anconeus muscle in some patients.
⬛ This previously unreported phenomenon occurred at a much higher rate in misdiagnosed patients, particularly those with posterolateral instability (83% of that subgroup), though the authors note this requires further investigation.
𝗧𝗵𝗲 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆 🎯
⬛ Misdiagnosing lateral elbow pain can lead to ineffective treatments and, in some cases, treatments that actively worsen the real condition (such as surgical tendon release for a patient actually suffering from instability).
⬛ For medical professionals, this study emphasizes that careful medical history taking is mandatory.
⬛ Evaluating the exact location of the pain, utilizing screening tests like the Cozen test, and maintaining a high degree of suspicion for younger patients or those with a history of trauma or swelling can effectively identify when tennis elbow isn't tennis elbow.
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⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️
Link to Article 👇
