Posterolateral Impingement

What is it?

Posterolateral impingement syndrome is pain caused by impingement in the posterolateral recess of the elbow between the posterolateral facet of the olecranon and posterolateral facet of the trochlea.  It is most commonly seen in people whose sports or activities require forced extension of the elbow such as boxers, canoeists and fencers.

How is it diagnosed?

The diagnosis should be suspected in patients who present with pain in the posterolateral recess of the elbow.  The pain is likely to be exacerbated by extension of the elbow and in most cases the patient’s activities require forced extension of the elbow.  On examination there is typically tenderness in the posterolateral recess and boggy synovitis may be palapable.  The pronation extension test will often be positive in these cases.  MRI arthrogram examination is the preferred investigation.  This may show a thickened posterolateral fold of synovium called a plica. This should be thicker than 3mm to be considered pathological.  Increased MRI signal suggestive of oedema within the bone may be found on both sides of the posterolateral recess.  In more advanced cases bony spurs or osteophytes may be seen.

How is it treated?

For mild symptoms the first line of treatment is physiotherapy to strengthen the triceps and anti-inflammatory analgesia.  Local steroid injection may be of benefit.  If symptoms fail to settle surgery may be indicated.  Arthroscopic or open debridement may be performed with good outcomes.

see also posteromedial impingement syndrome