• elbow
• lateral epicondylitis
• tendinosis
• tennis elbow

• Humans
• Tennis Elbow/diagnosis
• Diagnostic Errors/statistics & numerical data
• Male
• Female
• Middle Aged
• Prospective Studies
• Adult
• Risk Factors
• Diagnosis, Differential
• Aged
• Physical Examination
• Range of Motion, Articular
• Young Adult
• Magnetic Resonance Imaging
• Elbow Joint

• Baseball
• Epicondylitis
• Overhead athlete
• Physical examination
• Posterolateral rotatory instability
• Throwing elbow
• Ulnar collateral ligament
• Valgus extension overload

• Humans
• Physical Examination/methods
• Elbow Injuries
• Athletic Injuries/diagnosis
• Elbow Joint/anatomy & histology
• Elbow Joint/physiopathology
• Elbow Joint/physiology
• Biomechanical Phenomena
• Joint Instability/diagnosis
• Elbow/anatomy & histology

• Extensor carpi radialis brevis origin
• Lateral epicondylitis
• Magnetic resonance imaging
• Synovial fold

• Complications
• Lateral epicondylitis
• Revision surgery
• Salvage procedure
• Tennis elbow
• Treatment failure

• nursemaid’s elbow
• pulled elbow
• ultrasonography
• diagnostic image
• partial eclipse sign

• Child
• Humans
• Child, Preschool
• Elbow
• Elbow Joint/diagnostic imaging
• Elbow Injuries
• Radius
• Ultrasonography
• Joint Dislocations/diagnosis

• Humans
• Tennis Elbow/diagnostic imaging
• Tennis Elbow/therapy
• Forearm/surgery
• Arthralgia
• Orthopedic Procedures
• Ultrasonography

• common extensor tendon
• lateral epicondylitis
• shear wave elastography
• strain elastography

• Humans
• Elasticity Imaging Techniques
• Tennis Elbow/diagnostic imaging
• Ultrasonography

• Humans
• Elbow
• Arthralgia
• Pain
• Elbow Tendinopathy
• Musculoskeletal Diseases
• Tendinopathy
• Muscles

• Conservative management
• ECRB release
• Elbow arthroscopy
• Lateral epicondyle decortication
• Lateral epicondylitis
• Recalcitrant

We hypothesized that the treatment of recalcitrant lateral epicondylitis requires accurate identification of the painful area to promote remodeling of the degenerated extensor insertion and to stabilize the tendon origin during tendon healing. Thus, we performed tenodesis with bone marrow venting under local anesthesia for recalcitrant lateral epicondylitis.

Twenty patients (21 elbows) were treated with bone marrow venting at the painful area of the lateral epicondyle of the elbow and tenodesis using 2 soft anchors lateral to the capitellum (immediately distal to the painful area) and were followed up for ≥2 years. Patients were assessed using the numerical rating scale for pain and the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and objective evaluation included active range of motion.

The mean preoperative and postoperative pain scores were 7.5 and 0.5, respectively, indicating significant pain relief (P < .001). The mean preoperative and postoperative Quick Disabilities of the Arm, Shoulder, and Hand questionnaire scores were 44.2 and 1.0, respectively (P < .001). Two elbows had a slightly positive Thomsen test at the final visit. No recurrence of intra-articular symptoms induced by synovial fringe impingement was observed. Patients experienced more pain at the bone-tendon junction of extensors than at the tendon parenchyma.

Tenodesis with bone marrow venting under local anesthesia was effective for subjective patient satisfaction and positive clinical outcomes at ≥2 years of follow-up in patients with recalcitrant lateral epicondylitis. Intra-articular symptoms can be improved by stabilization of the lateral soft tissue without treatment for intra-articular lesions.

• Collateral ligament
• common extensor tendon
• elbow
• lateral overuse syndrome
• magnetic resonance imaging
• radiohumeral plica

• elbow tendinopathy
• joint instability
• lateral epicondylitis
• systematic review
• treatment outcome

• Elbow plica
• investigation
• prevalence
• synovial plica
• systematic review
• terminology

• Arthralgia
• Elbow/diagnostic imaging
• Elbow Joint/diagnostic imaging
• Humans
• Magnetic Resonance Imaging
• Synovial Membrane

• Recalcitrant
• Surgical options
• Tennis elbow
• Thortons technique

Surgical resection is usually required for symptomatic elbow plicae that have failed nonoperative therapy. However, evidence of surgical outcomes has not been presented.

To review the surgical outcomes for the treatment of synovial plicae in the radiocapitellar joint.

Systematic review; Level of evidence, 4.

We searched the PubMed, Ovid/MEDLINE, Cochrane Library, Google Scholar, and Embase databases using keywords as well as Medical Subject Headings terms and Emtree ([(elbow OR humeroradial joint OR radiohumeral joint) AND (meniscus OR plica)] OR snapping elbow OR snapping triceps OR synovial fold syndrome OR synovial fringe) for English-language studies. We conducted a systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

A total of 14 articles comprising four level 5 and ten level 4 studies were identified, including 279 patients (284 elbows). The triggering factors reported for 58 patients were heavy labor (29 patients; 50.0%), sporting activities (17 patients; 29.3%), and nonspecific trauma (12 patients; 20.7%). Overall, 92 patients (33.0%) were administered a steroid injection before surgery. Arthroscopic plica resection was performed in 266 patients (95.3%). Intraoperatively, plicae were mostly found in the posterior (44.0%) and posterolateral (28.6%) sites, and chondromalacia of the radial head was observed in 25 patients (9.2%). Of the reported surgical outcomes, 67.7% showed a resolution of symptoms. However, 9.3% of patients had residual symptoms, which were likely associated with pre-existing radial head chondromalacia. The complication rate was reported as 1.8%.

Symptomatic elbow plicae were mostly treated arthroscopically, with most of the results being favorable. Pre-existing chondromalacia and the underestimation of concomitant intra-articular abnormalities may yield an inferior outcome.

• elbow plicae
• surgical outcome
• synovial plicae
• systematic review

A synovial plica (fold) is normal anatomic finding, and occurs in 86–100% of cases; however, symptomatic plica is much less common (7.2–8.7% of all elbow arthroscopies).

Cite this article: EFORT Open Rev 2020;5:549-557. DOI: 10.1302/2058-5241.5.200027

• elbow
• elbow arthroscopy
• plica syndrome
• snapping elbow
• synovial fold
• synovial plica

Radiocapitellar joint snapping due to the presence of synovial plica has been described as a contributory intra-articular pathology of lateral epicondylitis (LE).

The arthroscopic modified Bosworth technique can provide a safe and favorable outcome for refractory LE with radiocapitellar snapping.

Case series; Level of evidence, 4.

Patients treated with the arthroscopic modified Bosworth procedure for refractory LE with radiocapitellar joint snapping were included in this study. The sequential surgical procedures included excision of the upper portion of the anterolateral annular ligament, removal of the synovial plicae, and release of the extensor carpi radialis brevis for all patients. Clinical outcomes were measured at a minimum 1-year follow-up.

A total of 22 patients with a mean ± SD age of 51.2 ± 10.4 years were included in this study. The mean follow-up was 29.4 ± 7.7 months (range, 21-42 months). The overall visual analog scale score (from preoperative to final follow-up) was 7.5 ± 1.2 vs 2.5 ± 1.8 (P < .001); flexion-extension motion arc was 133.8° ± 11.2° vs 146.4° ± 7.1° (P = .001); pronation-supination motion arc was 101.8° ± 9.2° vs 141.7° ± 10.2° (P = .001); Disabilities of the Arm, Shoulder and Hand score was 54.5 ± 13.2 vs 3.6 ± 4.1 (P < .001); and Mayo Elbow Performance Score was 51.9 ± 12.2 vs 84.3 ± 10.3 (P < .001).

Radiocapitellar joint snapping may coexist with LE as a disease spectrum. The arthroscopic modified Bosworth technique provides safe and favorable outcomes for patients with refractory LE associated with radiocapitellar joint snapping.

• arthroscopy
• elbow
• lateral epicondylitis
• refractory
• snapping radiocapitellar

• Chronic pain
• Elbow joint
• Meniscus
• Plica
• Tennis elbow

• arthroscopy
• chondromalacia
• elbow
• impingement
• plica
• radiocapitellar joint

• Adolescent
• Adult
• Arthralgia/etiology
• Arthroscopy/methods
• Debridement/methods
• Elbow Joint/diagnostic imaging
• Elbow Joint/pathology
• Elbow Joint/surgery
• Female
• Humans
• Joint Diseases/complications
• Joint Diseases/diagnosis
• Joint Diseases/surgery
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Retrospective Studies
• Synovial Membrane/diagnostic imaging
• Synovial Membrane/pathology
• Young Adult

• MRI
• Plica
• arthroscopy
• elbow
• lateral epicondylitis
• synovial fold

To develop practical guidelines for diagnosis and treatment of the painful snapping elbow syndrome (SE).

Clinical studies were searched in the databases PubMed and Scopus for the phrases “SE”, “snapping triceps”, “snapping ulnar nerve” and “snapping annular ligament”. A total of 36 relevant studies were identified. From these we extracted information about number of patients, diagnostic methods, patho-anatomical findings, treatments and outcomes. Practical guidelines for diagnosis and treatment of SE were developed based on analysis of the data. We present two illustrative patient cases-one with intra-articular pathology and one with extra-articular pathology.

Snapping is audible, palpable and often visible. It has a lateral (intra-articular) or medial (extra-articular) pathology. Snapping over the medial humeral epicondyle is caused by dislocation of the ulnar nerve or a part of the triceps tendon, and is demonstrated by dynamic ultrasonography. Treatment is by open surgery. Lateral snapping over the radial head has an intra-articular pathology: A synovial plica, a torn annular ligament or a meniscus-like remnant from the foetal elbow. Pathology can be visualized by conventional arthrography, magnetic resonance (MR) arthrography, high resolution magnetic resonance imaging (MRI) and arthroscopy, while conventional MRI and radiographs often turn out normal. Treatment is by arthroscopic or eventual open resection. Early surgical intervention is recommended as the snapping can damage the ulnar nerve (medial) or the intra-articular cartilage (lateral). If medial snapping only occurs during repeated or loaded extension/flexion of the elbow (in sports or work) it may be treated by reduction of these activities. Differential diagnoses are loose bodies (which can be visualized by radiographs) and postero-lateral instability (demonstrates by clinical examination). An algorithm for diagnosis and treatment is suggested.

The primary step is establishment of laterality. From this follows relevant diagnostic measures and treatment as defined in this guideline.

• Elbow
• Arthroscopy
• Surgery
• Diagnosis
• Ultrasonography
• Snapping

Chronic elbow pain has several causes. Instability pain is one of the differential diagnosis. Posterolateral rotatory instability (PLRI) of the elbow results from lateral collateral ligament (LCL) insufficiency. This instability has been recognized in association with trauma of the elbow. The standard treatment of LCL insufficiency is ligament reconstruction with a tendon graft. Treatment outcome of LCL reconstruction in atraumatic PLRI cases has been rarely reported. This study reports the results of LCL reconstruction in patients with chronic lateral elbow pain from atraumatic PLRI.

Data were collected from 36 patients referred to our institution for surgery because of chronic lateral elbow pain between November 2011 and June 2015. Six patients with atraumatic PLRI underwent LCL reconstruction with tendon graft. Demographic data, number of steroid injections, postoperative clinical examination, Mayo Elbow Performance Index, 11-item version of the Disabilities of the Arm, Shoulder and Hand score, and complications were recorded with a mean follow-up of 24 months.

Reconstruction resulted in significant improvement of pain. The mean postoperative Mayo Elbow Performance Index score was 97.5 (range, 95-100), and the score of the 11-item version of the Disabilities of the Arm, Shoulder, and Hand was 9 (range, 3.3-33). Postoperative instability test results were negative in all patients. Mean postoperative range of motion was 136° in flexion and 1° in extension. No complications were detected at the follow-up assessment.

We consider LCL reconstruction is one of the reference treatments for atraumatic PLRI because it provides effective and reliable results.

• Lateral collateral ligament reconstruction
• Lateral elbow instability
• Lateral elbow pain
• Posterolateral rotatory instability
• Recalcitrant lateral epicondylitis
• Recalcitrant tennis elbow

• elbow trauma, elbow instability, SMILE syndrome MRI, MR arthrography

• Cumulative Trauma Disorders/diagnostic imaging
• Diagnostic Imaging/methods
• Elbow Joint/diagnostic imaging
• Fractures, Bone/diagnostic imaging
• Humans
• Joint Dislocations/diagnostic imaging
• Joint Instability/etiology
• Joint Instability/therapy
• Tennis Elbow/diagnostic imaging
• Elbow Injuries

• Capsular plication
• Elbow arthroscopy
• Elbow instability
• Lateral elbow pain
• Lateral epicondylitis
• Laxity

Magnetic resonance imaging (MRI) may be useful to diagnose a posterolateral plica syndrome of the elbow joint because this syndrome has less clear clinical features. The purposes of this study were to document mediolateral and sagittal dimensions of a posterolateral synovial fold and to determine the proportion of subjects with the posterolateral plica in asymptomatic elbows. We also aimed to determine whether the dimensions of the posterolateral synovial fold and the prevalence of the plica differ between symptomatic and asymptomatic subjects.

This retrospective review of prospectively collected data included 50 asymptomatic elbows (asymptomatic group) and 14 elbows with arthroscopically confirmed posterolateral plicae (plica group). The mediolateral and sagittal dimensions of the posterolateral synovial fold were measured. In addition, the criteria for the prevalence of posterolateral plica was determined with conventional MRI as synovial fold dimension ≥ 3 mm and coverage of radial head by synovial fold ≥ 30%.

The plica group showed larger posterolateral synovial fold dimensions compared to the asymptomatic group. The median mediolateral and sagittal dimensions of the synovial fold in the asymptomatic group were 3.8 mm and 4.7 mm, respectively. Dimensions in the plica group were 7.0 mm and 7.4 mm, respectively. When the presence of posterolateral plica was determined using the dimension criteria, there was no difference in the prevalence of the plica between the asymptomatic and the plica group. However, using the coverage criteria, the prevalence of posterolateral elbow plica was significantly greater in the plica group than the asymptomatic group (64% vs. 18%; p < 0.001).

The patients who underwent arthroscopic surgery for posterolateral plica syndrome had larger dimensions of the posterolateral synovial fold and higher prevalence of the posterolateral plica on conventional MRI compared to the asymptomatic subjects.

• Adult
• Elbow Joint/diagnostic imaging
• Elbow Joint/metabolism
• Humans
• Joint Diseases/diagnostic imaging
• Joint Diseases/metabolism
• Male
• Prospective Studies
• Retrospective Studies
• Syndrome
• Synovial Fluid/diagnostic imaging
• Synovial Fluid/metabolism

Introduction: Painful Synovial Plicae (SP) in the posterolateral corner of the radiohumeral joint may be confused with lateral epicondylitis. The SP may impinge between the radial head and the humeral capitellum causing pain and snapping. The aim of this study was to evaluate the short-term results after arthroscopic plica resection of the elbow.

Methods: In this case series, we included a consecutive series of 64 arthroscopies (60 patients) with arthroscopic plica resection of the elbow. Inclusion criteria were six months of lateral elbow pain and unsuccessful conservative treatment. Patients had either ultrasonography verified plicae or pain on palpation of the plica. Patients were evaluated with an Oxford Elbow Score (OES) preoperatively, after three months and after mean 22 months (range: 12–31) of follow-up. Furthermore, baseline characteristics were recorded including, gender, age, body mass index (BMI), occupation, smoking and cartilage damage.

Results: The mean age was 44 years (range: 18–66). In 13 elbows, International Cartilage Repair Society (ICRS) grade 1 lesions were present in association with the plica. Preoperatively the mean OES was 19 (95% CI: 17–20). At three and 22 month follow-up the OES increased to 33 (95% CI: 30–36) and 35 (95% CI: 32–38), respectively (p < 0.001). Cartilage injury and gender did not affect the outcome. We reported no complications.

Discussion: Arthroscopic plica resection of the elbow indicates an improved OES after three and 22 months. A randomized prospective trial is needed to validate the effect of arthroscopic treatment of synovial elbow plicae.

• Arthroscopic tennis elbow release
• Lateral epicondylitis
• Randomized controlled trial
• Tennis elbow

• epicondylalgia
• prognosis
• tennis elbow

• arthroscopy
• tennis elbow

• Athlete
• Elbow injuries
• Neuritis
• OCD
• Throwing
• UCL
• VEOS

• Boyd–McLeod
• lateral epicondylitis
• open release
• tennis elbow

• Adolescent
• Adult
• Arthralgia/diagnosis
• Bone Diseases/diagnosis
• Child
• Elbow Joint
• Female
• Fractures, Bone/diagnosis
• Humans
• Joint Instability/diagnosis
• Male
• Nerve Compression Syndromes/diagnosis
• Tennis Elbow/diagnosis
• Tennis Elbow/physiopathology

• Accidents, Occupational
• Diagnosis, Differential
• Humans
• Joint Loose Bodies/diagnosis
• Joint Loose Bodies/surgery
• Magnetic Resonance Imaging
• Male
• Pain Measurement
• Wrist Joint
• Young Adult