Lateral elbow pain in adults: a review of the less common causes

Lateral elbow pain and tennis elbow have been considered almost synonymous, in that historically all patients with lateral elbow pain were assumed to have tennis elbow. With the evolution of diagnostic imaging, elbow arthroscopy and further understanding of the pathological processes, alongside analysis of failed tennis elbow treatment, a whole host of possible differential diagnoses that might cause lateral elbow pain became recognized. In addition to tendinopathies (tennis and golfers elbow), these include intraarticular mechanical issues (radiocapitellar plica and snapping annular ligament), elbow instability, nerve compression syndromes, osteochondral defects and degenerative joint disease (radiocapitellar joint arthritis). Accurate clinical assessment and diagnosis is key, alongside selective use of investigations that can confirm or refute diagnoses and guide ongoing management. This article serves to provide an overview of the history, examination findings, investigations and management options for lateral elbow pain. Whilst we will cover the whole scope of possible diagnoses responsible for lateral elbow pain, we will not be considering in detail those covered in other articles in this issue (tennis elbow, osteochondritis dissecans, elbow instability). The focus of this article will be to elaborate on the tips and tricks within the clinical assessment, and how to properly assess the lateral side of the elbow. We will mention the rarer conditions encountered (posterior interosseous nerve entrapment, synovial plica syndrome and snapping annular ligament) and discuss the reconstructive ladder for lateral sided degenerative joint disease.