Skip to main content
SpringerLink
Log in

Elbow MR imaging findings in patients with synovial fringe syndrome

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To describe imaging findings in patients with synovial fringe (SF) syndrome of the elbow and to compare with a control population.

Materials and methods

Nine patients (5 men, 4 women) whose mean age was 35.7 years were diagnosed with SF syndrome and had undergone preoperative elbow MRI. The radiohumeral (RH) plica was assessed for thickness, cross-sectional area, coverage of one third or more of the radial head, blunting of the free edge, and T2 signal intensity abnormality. Other abnormalities of the RH joint were also assessed, including adjacent articular cartilage defects, subcortical bone marrow signal abnormality in the capitellum, and synovitis. Results were compared with 15 control patients who were asymptomatic laterally and posteriorly.

Results

Mean thickness and cross-sectional area of the RH plica were 1.8 mm and 19.4 mm2 respectively in controls, compared with 2.5 mm and 21.9 mm2 respectively in symptomatic patients. No statistically significant differences in the distribution of the mean thickness or cross-sectional area of the RH plica were found between the two groups. However, 67% of SF syndrome patients had a RH plica thickness greater than 2.6 mm compared with only 13% of controls (p = 0.021). Other abnormalities of the RH plica occurred more frequently in patients with SF syndrome compared with controls, but were not statistically significant.

Conclusion

In patients presenting with posterolateral pain or mechanical symptoms in the elbow, RH plica thickness greater than 2.6 mm on elbow MRI examinations may help identify patients with SF syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Clarke RP. Symptomatic, lateral synovial fringe (plica) of the elbow joint. Arthroscopy. 1988;4(2):112–6.

    Article  PubMed  CAS  Google Scholar 

  2. Ruch DS, Papadonikolakis A, Campolattaro RM. The posterolateral plica: a cause of refractory lateral elbow pain. J Shoulder Elbow Surg. 2006;15(3):367–70.

    Article  PubMed  Google Scholar 

  3. Commandre FA, Taillan B, Benezis C, Follacci FM, Hammou JC. Plica synovialis (synovial fold) of the elbow. Report on one case. J Sports Med Phys Fitness. 1988;28(2):209–10.

    PubMed  CAS  Google Scholar 

  4. Akagi M, Nakamura T. Snapping elbow caused by the synovial fold in the radiohumeral joint. J Shoulder Elbow Surg. 1998;7(4):427–9.

    Article  PubMed  CAS  Google Scholar 

  5. Antuna SA, O’Driscoll SW. Snapping plicae associated with radiocapitellar chondromalacia. Arthroscopy. 2001;17(5):491–5.

    Article  PubMed  CAS  Google Scholar 

  6. Kim DH, Gambardella RA, Elattrache NS, Yocum LA, Jobe FW. Arthroscopic treatment of posterolateral elbow impingement from lateral synovial plicae in throwing athletes and golfers. Am J Sports Med. 2006;34(3):438–44.

    Article  PubMed  Google Scholar 

  7. Steinert AF, Goebel S, Rucker A, Barthel T. Snapping elbow caused by hypertrophic synovial plica in the radiohumeral joint: a report of three cases and review of literature. Arch Orthop Trauma Surg. 2010;130(3):347–51.

    Article  PubMed  Google Scholar 

  8. Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M. Ligaments and plicae of the elbow: normal MR imaging variability in 60 asymptomatic subjects. Radiology. 2010;257(1):185–94.

    Article  PubMed  Google Scholar 

  9. Awaya H, Schweitzer ME, Feng SA, Kamishima T, Marone PJ, Farooki S, et al. Elbow synovial fold syndrome: MR imaging findings. AJR Am J Roentgenol. 2001;177(6):1377–81.

    Article  PubMed  CAS  Google Scholar 

  10. Huang GS, Lee CH, Lee HS, Chen CY. A meniscus causing painful snapping of the elbow joint: MR imaging with arthroscopic and histologic correlation. Eur Radiol. 2005;15(12):2411–4.

    Article  PubMed  Google Scholar 

  11. Fukase N, Kokubu T, Fujioka H, Iwama Y, Fujii M, Kurosaka M. Usefulness of MRI for diagnosis of painful snapping elbow. Skeletal Radiol. 2006;35(10):797–800.

    Article  PubMed  Google Scholar 

  12. Sanghi A, Ly JQ, Bush RJ, Folio LR. Case for diagnosis. Elbow synovial fold syndrome. Mil Med. 2007;172(12):xii–xiii.

    PubMed  Google Scholar 

  13. Kotnis NA, Chiavaras MM, Harish S. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol. 2012;41(4):369–86.

    Article  PubMed  Google Scholar 

  14. Meyers AB, Kim HK, Emery KH. Elbow plica syndrome: presenting with elbow locking in a pediatric patient. Pediatr Radiol. 2012; doi:10.1007/s00247-012-2407-1.

    Google Scholar 

  15. Merida-Velasco JA, Sanchez-Montesinos I, Espin-Ferra J, Merida-Velasco JR, Rodriguez-Vazquez JF, Jimenez-Collado J. Development of the human elbow joint. Anat Rec. 2000;258(2):166–75.

    Article  PubMed  CAS  Google Scholar 

  16. Isogai S, Murakami G, Wada T, Ishii S. Which morphologies of synovial folds result from degeneration and/or aging of the radiohumeral joint: an anatomic study with cadavers and embryos. J Shoulder Elbow Surg. 2001;10(2):169–81.

    Article  PubMed  CAS  Google Scholar 

  17. Duparc F, Putz R, Michot C, Muller JM, Freger P. The synovial fold of the humeroradial joint: anatomical and histological features, and clinical relevance in lateral epicondylalgia of the elbow. Surg Radiol Anat. 2002;24(5):302–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA

    Brian C. Ruiz de Luzuriaga, Clyde A. Helms & Emily N. Vinson

  2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Box 3850, Durham, NC, 27710, USA

    Andrzej S. Kosinski

Authors
  1. Brian C. Ruiz de Luzuriaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Clyde A. Helms
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrzej S. Kosinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emily N. Vinson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emily N. Vinson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ruiz de Luzuriaga, B.C., Helms, C.A., Kosinski, A.S. et al. Elbow MR imaging findings in patients with synovial fringe syndrome. Skeletal Radiol 42, 675–680 (2013). https://doi.org/10.1007/s00256-012-1523-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-012-1523-1

Keywords

Search

Navigation