The radiohumeral (radiocapitellar) joint is the articulation between the spherical capitellum and the concave radial head, located within the common elbow synovial joint. It participates in both elbow flexion-extension and forearm rotation, making it the most versatile of the three elbow articulations, and the radial head acts as an important secondary restraint to valgus stress. Osteochondritis dissecans of the capitellum, radial head fractures, plica syndrome and posterolateral rotatory instability all affect this lateral compartment.
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Pain with resisted forearm rotation suggests radiohumeral joint pathology, while pain with resisted wrist extension points to the common extensor origin. Capitellar osteochondritis dissecans from repetitive valgus compression in young throwers and gymnasts causes lateral pain and locking; stable lesions are treated with rest, unstable ones with arthroscopic drilling, fixation or grafting. Radial head arthroplasty for comminuted fractures must restore correct radial head height: overlengthening overstuffs the joint, while shortening allows proximal radius migration and DRUJ problems. Excising the radial head when the medial collateral ligament is deficient produces valgus instability. Lateral ulnar collateral ligament deficiency allows posterolateral rotatory instability, shown by the lateral pivot-shift test.
Radiohumeral joint degeneration producing lateral elbow pain managed with debridement or radial head arthroplasty for significant arthritis.
Subchondral bone and cartilage injury of the capitellum in adolescent throwers and gymnasts, causing lateral pain, loose bodies and locking; managed by rest or arthroscopic treatment depending on fragment stability.
Lateral ulnar collateral ligament insufficiency lets the radial head and ulna rotate off the humerus, causing clicking and apprehension; diagnosed with the lateral pivot-shift test and treated by ligament reconstruction.
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