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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

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

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 Arthroscopy Rehab Protocol.
  • Elbow Outcome Measures.

Elbow Synovial Plica Review References