Subchondral osseous cystic lesion of the elbow was diagnosed as a cause of lameness in 6 horses. Persistent lameness and signs of degenerative joint disease developed in the first 3 horses treated conservatively with confinement. Subsequently, 3 horses were each treated by extra-articular enucleation of the cystic cavity via the proximal-medial aspect of the radius. Compared with conservative management, better long-term success (determined by return of athletic soundness and less evidence of degenerative joint disease) was achieved with surgical curettage of elbow subchondral cystic lesions.