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.
- Has been reported in basketball, golf and tennis players.
Elbow Synovial Plica 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, lateral and 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 arthroscopy with 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
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