Elbow Synovial Plica

synonyms: posterolateral synovial plica, intra-articular plica syndrome, radiocapitellar synovial plica

Elbow Synovial Plica ICD-9

Elbow Synovial Plica Etiology / Epidemiology / Natural History

• Synovial plica may cause pain and snaping laterally.
• Hypertrophic synovial plicae associated with localized synovitis and radiocapitellar chondromalacia.
• Generally posterolateral synovial plica.
• Uncommon
• Has been reported in basketball, golf and tennis players.

Elbow Synovial Plica Anatomy

• See also Elbow anatomy

Elbow Synovial Plica Clinical Evaluation

• Diffuse lateral elbow pain.
• May have painful joint snapping ocurring maximally in terminal extension and supination.
• Flexion-pronation test: snap reproduced by passively flexing a pronated arm in the range of 90º to 110º of flexion (Antuna SA, Arthroscopy 2001;17(5):491).

Elbow Synovial Plica Xray / Diagnositc Tests

• A/P, lateraland oblique elbow films indicated, generally normal.
• Arthrogram MRI: consider to evaluate for loose bodies.

Elbow Synovial Plica Classification / Treatment

• Initial: Rest, activity modifications, NSAIDs
• If fails non-operative management: Elbow arthroscopywith resection of the plica.
• Elbow arthroscopy with plica excision outcomes: 71% complete relief of symptoms (Antuna SA, Arthroscopy 2001;17(5):491).

Elbow Synovial Plica Associated Injuries / Differential Diagnosis

• Lateral Epicondylitis
• Cerival disease with radiculopathy
• Intraarticular elbow loose body
• Elbow arthritis
• Radiocapitellar Arthritis
• Posterolateral rotatory instability
• Olecranon bursitis
• Posterior olecranon impingement
• PIN entrapement
• Snapping triceps

Elbow Scope Complications

• 11% minor complications, 0.8% major (Kelley EW, JBJS 2001;83A:25).
• Overall approximately 10% complication rate
• Compartment syndrome
• Septic arthritis / infection: 0.8% (Kelley EW, JBJS 2001;83A:25).
• Nerve injury (median, ulnar, radial, posterior interosseous): use of retractors effectively decreases risk.
• Cutneous neuromas (associated with portal placement).
• 4%transient radial-nerve palsy after intraarticular anesthetic injection
• Vascular injury
• Prolonged drainage (portal sites): 4% aseptic drainage
• Stiffness / flexion contracture

Elbow Synovial Plica Follow-up Care

• Post-op: compressive dressing, elevation
• 1 week: Start PT focused on ROM and strengthening. AAROM, PROM.  AROM, free weights start at 3 weeks.
• 6 weeks: progressive sport specific activity.
• 3 months: Return to sport / full activities.
• Elbow scope rehab protocol.
• Elbow Outcome measures.

Elbow Synovial Plica Review References

• Ruch DS, JSES 2006;15:367
• Kim DH, AJSM 2006;34:438