Peripheral Nerve Entrapment Mimics of Overuse Syndromes: A Symptom-First Diagnostic Framework.

Abstract

Repetitive use injuries are commonly seen by musculoskeletal providers, usually in the form of tendinopathies. However, focal peripheral nerve entrapment can mimic or coexist with tendon pathology, particularly when weakness, sensory symptoms, or imaging findings are subtle or nonspecific. This review provides a practical, symptom-first framework to help clinicians distinguish tendon-dominant, nerve-dominant, and mixed presentations in clinical practice. Five clinically relevant tendon-nerve mimic pairs are emphasized: (1) rotator cuff tendinopathy versus suprascapular neuropathy; (2) lateral epicondylitis versus radial tunnel syndrome; (3) iliotibial band syndrome versus common peroneal neuropathy; and (4) peroneal tendinopathy versus superficial or deep peroneal nerve entrapment; (5) plantar fasciitis versus tarsal tunnel syndrome or Baxter nerve entrapment. Across these conditions, diagnosis is most strongly informed by symptom pattern, pain distribution, and focal neurologic deficits, with imaging and adjunctive testing used selectively when they are likely to clarify the diagnosis or change management. Therefore, a symptom-first approach may reduce diagnostic anchoring, improve recognition of atypical or refractory presentations, and support more targeted rehabilitation strategies.