| Radiocapitellar Plica Syndrome as a Refractory Lateral Elbow Pain |
|
Man-Kue Bae, Seok-Whan Song, Seung-Koo Rhee, Eun-Su Shin |
| 불응성 외측 주관절 통증의 원인으로서 요소두 추벽 증후군 |
|
배만규, 송석환, 이승구, 신은수 |
|
|
|
|
| Abstract |
Purpose
Radiocapitellar plica causes lateral elbow pain, and frequently be misdiagnosed as lateral epicondylitis. We experienced 12 patients of the disease as an intractable lateral elbow pain, and report the results of treatment. Materials and Methods: Twelve patients, operated in our hospital from 1999 to 2006, were retrospectively reviewed. There were 8 female and 4 male patients. Mean age was 45.6 years (range 41~52 years). Preoperative evaluation included meticulous physical evaluation, plain radiographs, and MRI. The diagnosis criteria were pain on lateral elbow joint, maximal direct tenderness over the radiocapitellar joint, synovial plica in the radiocapitellar joint in MRI study, symptom relief after local anesthetic injection. Soft tissue shadow between radial head and capitellum in plain x-ray films were not constant, but if exist, it was helpful to diagnosis and proceed to MRI study. Five patients were combined with true lateral epicondylitis and operated at the same time with the excision of plica. Three patients had mild limited motion of elbow joint preoperatively. After the conservative treatment with NSAID, stretching exercise of extensor group muscles, occasional steroid injection, at least 3 months, if there was persistent discomfort or pain, the patient was undergone for the surgical excision of the identified synovial plica. Incision was made over the lateral epicondyle to the anconeus muscle, and the annular ligament was divided longitudinally. Joint was opened and retracted anterior capsule and anterior half of annular ligament anteriorly, and the synovial plica, usually inflamed and hypertrophied, was excised. After the 2 weeks immobilization with splint, range of motion (ROM) exercise was started. Clinical results of the operation were evaluated with ROM, visual analog pain score (VAS), grip strength. Results: Mean follow-up period after operation was 12.3 months (range 3~24 months) and mean conservative period before operation was 16 months (range 3~42 months). All patients were relieved from the lateral elbow pain and regained full ROM and grip strength. There were no surgery-related complications or recurrence during follow-up period. Conclusion: Radiocapitellar synovial plica of the elbow is one of the potential causes of lateral elbow pain, and should not be confused with lateral epicondylitis. Symptoms result from mechanical impingement between radial head and capitellum, and surgical excision would be the only final definitive treatment. |
| |
|
PDF Links
Full text via DOI
Download Citation
