Lateral and Medial Elbow Pain: Minor Instabilities

Elbow stability is conferred by primary and secondary structures including: bones, ligaments, and muscles. Mediolateral elbow stability is important for everyday life activities and plays a special role when performing throwing gestures, therefore manual workers and overhead athletes are at higher risk of developing elbow pain. Medial and lateral elbow pain is often nonspecific yet common findings in patients complaining of elbow problems. A careful history taking and clinical and radiological examinations are mandatory. Ligamentous tears causing micro-instabilities, indeed, are a potential cause of pain. Magnetic resonance imaging (MRI) or computed tomography (CT) scan can help the physician to have a more comprehensive evaluation of the injury pattern. When the lateral compartment is involved, according to the entity of the trauma, either posterolateral rotatory instability (PLRI) and symptomatic minor instability of the lateral elbow (SMILE) develop. On the other hand, when the medial compartment is affected, either valgus instability and valgus extension overload syndrome may ensue. Surgical treatment for these conditions is indicated only in cases of symptomatic patients with functional limitations. Open or arthroscopic repair of the injured ligamentous structures are both valid options for these patients.