A snapping outer elbow is not always just tennis elbow
In short
When pain on the outside of the elbow comes with a snap as you flex with the forearm pronated, one reported cause is a degenerative annular ligament catching in the radiocapitellar joint and then relocating. In a series of four patients, all had tenderness at the lateral epicondyle together with snapping, and MRI consistently showed high signal at the origin of the ECRB — the finding of lateral epicondylitis. All four failed conservative treatment; after partial resection of the ligament plus ECRB debridement, the Mayo Elbow Performance Score rose from a mean of 73.8 to 100.
Pain on the outside of the elbow is common in lifters. Curls, pull-ups, rows and anything held with a fixed wrist all irritate the same spot, and most of the time the answer is lateral epicondylitis — tennis elbow. But when the pain arrives with a snap, and that snap repeats in one specific movement, this case series points at a second structure.
What were the cases?
Four patients operated on at three institutions between 2010 and 2018 — two men and two women, mean age 59 (range 45–69), followed for a mean of 10.5 months (6–12). Assessment before surgery included physical examination, x-rays, MRI and the Mayo Elbow Performance Score. All four had marked tenderness at the lateral epicondyle of the humerus alongside the snapping.
What produces the snap?
The intraoperative view answers it. A degenerative, thickened annular ligament was entrapped inside the radiocapitellar joint, and it was seen repositioning during elbow flexion with the forearm pronated. The snap is the moment the ligament relocates. Which is why the distinguishing feature here is not where it hurts but the condition under which it repeats: pronation plus flexion.
How does it separate from tennis elbow?
It does not separate — that is the point. All four patients also had lateral epicondylitis, with raised MRI signal at the ECRB origin. This is not a condition that arrives instead of tennis elbow; it arrives on top of it. So two people carrying the same diagnosis can follow different courses depending on whether snapping is part of the picture. These four had not responded to conservative treatment and went to surgery: partial resection of the degenerative ligament with ECRB debridement. Their mean score moved from 73.8 to 100.
What does it change in training?
What this paper offers a lifter is not a surgical decision but an observation to record. When the outside of your elbow hurts, note whether there is a snap and which movement produces it, not just the pain. And if conservative measures — lowering load, changing grip, dropping the provocative movement — leave the same spot hurting the same way after several weeks, that is the point where a diagnosis matters. In the logs, the bench press and grip-dependent accessory work usually stall first, and no number tells you that the stall came from a joint rather than from strength. Training the limiting factor applies to pain as much as to lifts.
This is rare. The series is four patients gathered across three institutions over eight years, with a mean age of 59. A noise in the elbow does not place you in this group, and if it hurts, that is a question for a clinician rather than for an article.
Frequently asked questions
What causes a snap on the outside of the elbow?
One reported cause is a degenerative annular ligament becoming entrapped in the radiocapitellar joint. It snaps as the ligament relocates during flexion with the forearm turned inward. The condition is rare and cannot be diagnosed by the sound alone.
How is it distinguished from tennis elbow?
All four patients in the series also had lateral epicondylitis, with raised MRI signal at the ECRB origin. The distinguishing feature was not the pain itself but snapping that repeated with pronation and flexion together.
Is surgery required?
These four patients had surgery because conservative treatment failed. After partial resection of the ligament and ECRB debridement, Mayo Elbow Performance Scores rose from a mean of 73.8 to 100. It is not the first decision at the conservative stage.
Should I stop training if my elbow clicks?
A painless noise and a painful snap are different situations. If pain comes with it, avoid that angle and grip, reduce load and watch the response — and if nothing changes after several weeks, see a clinician.
How common is this?
Rare. The study collected four cases across three institutions between 2010 and 2018, and the patients averaged 59 years of age.
Source: PubMed