- Visibility 45 Views
- Downloads 26 Downloads
- Permissions
- DOI 10.18231/pjms.v.15.i.2.284-288
-
CrossMark
Meniscus or not: The radio-humeral synovial folds & its clinical importance
- Author Details:
-
Sarbani Das
-
Pallab Kumar Saha
-
Gargi Mukherjee
-
Swapan Bhattacharjee
-
Arpita Sen *
Gargi Mukherjee
Arpita Sen *
Introduction: Synovial folds present within the humero-radial compartment of elbow joint are prone to chronic inflammation in repeated users of elbow joint, mainly in athletes. Generally, these conditions are well managed with conservative medications, but if not cured, arthroscopic guided resection is suggested by researchers for maximum post-operative painless movement restoration.
Aim: Aim of the present study was to find out the incidence of synovial folds of humero-radial part of synovial joint and gross structural variability of these folds along with histological structural details.
Materials and Methods: 50 elbows from 25 embalmed cadavers were dissected in between March 2022 to February 2024. Incidence, morphology & morphometry of synovial folds were recorded. Part of the folds dissected out and stained with Hematoxylin eosin stain after tissue processing.
Results: Posterolateral synovial fold is present in all the elbows followed by anterior fold which is present in 71% cases. Incidence of lateral fold and olecranon fold was almost similar 28% and 27% in sequence. Postero-lateral folds are largest in dimension, about 26.4 mm in length, 4.8mm in width and 2.9mm in thickness followed by anterior fold and lateral fold. The olecranon fold is smallest in all the dimensions measuring about 3.2mm in length, 2.7mm in width and 1.6 mm thickness. In hematoxylin eosin staining, it was found that all the folds are made up of fibrous tissue (predominantly collagen) without any chondrocytes. More specifically in the lateral synovial folds the collagen fibres are densely packed around an axis with very less amount of loose areolar tissue, but in rest of folds the collagen fibres are arranged loosely.
Conclusion: Presence of such fibrous plica within the interposed surfaces of humero-radial part of elbow joint must be kept in mind during diagnosing and managing patients of persistent /chronic lateral elbow pain. Chronic inflammation of these plica or folds results into thickening of the folds which restrict the joint mobility and produces snapping elbow syndrome.
References
- Isogai S, Murakami G, Wada T, Ishii S. Which morphologies of synovial folds result from degeneration and/or aging of the radio humeral joint: an anatomic study with cadavers and embryos. J Shoulder Elbow Surg. 2001;10(2):169–81.
- Duparc F, Putz R, Michot C, Muller JM, Fréger 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.
- Koh S, Morris RP, Andersen CL, Jones EA, Viegas SF. Ultrasonographic examination of the synovial fold of the radio humeral joint. J Shoulder Elbow Surg. 2007;16(5):609–15.
- 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.
- Steinert AF, Goebel S, Rucker A, Barthel T. Snap ping elbow caused by hypertrophic synovial plica in the radio humeral joint: a report of three cases and review of literature. Arch Orthop Trauma Surg. 2010;130(3):347–51.
- 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.
- Antuna SA, O’Driscoll SW. Snapping plicae associated with radiocapitellar chondromalacia. Arthroscopy 2001;17(5):491–5.
- Clarke RP. Symptomatic, lateral synovial fringe (plica) of the elbow joint. Arthroscopy. 1988;4(2):112–6.
- Fabié F, Brouchet A, Accadbled F, Verhaegue L, de Gauzy JS, Cahuzac JP. Does the meniscus exist in the elbow joint in children? Surg Radiol Anat. 2003;25(1):73–5.
- Kang ST, Kim TH. Lateral sided snapping elbow caused by a meniscus: two case reports and literature review. Knee Surg Sports Traumatol Arthrosc. 2010;18(6):840–4.
- Young B, O’Dowd G, Woodford P. Wheater’s functional histology: a text and colour atlas [Internet]. Sixth edition. Philadelphia, PA: Churchill Livingston/Elsevier; 2014.
- Cerezal L, Rodriguez Sammartino M, Canga A, Capiel C, Arnaiz J, Cruz A, Rolón A. Elbow synovial fold syndrome. AJR Am J Roentgenol. 2013;201(1):W88–96
- Choi SH, Ji SK, Lee SA, Park MJ, Chang MJ. Magnetic resonance imaging of porsterolateral plica of the elbow joint: Asymptomatic vs. Symptomatic subjects. PLoS ONE. 2017;12(6):e0174320.
- Carro LP, Arriaza CR, Fernandez OP, Fernandez JAD, Sanchez LT. Elbow Posterolateral Synovial Fold Syndrome: A Case Series with a Modified Arthroscopic Technique. J Orth Clin Res. 2022;1(1):1–
- Rajeev A, Pooley J. Arthroscopic resection of humeroradial synovial plica for persistent lateral elbow pain. J Orthop Surg. 2015;23(1):11–4.
- Huang GS, Lee CH, Lee HS, Chen CY. MRI, Arthroscopy, and Histologic Observations of an Annular Ligament Causing Painful Snapping of the Elbow Joint. AJR Am J Roentgenol. 2005;185(2):397–9.
- 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.
- Bonczar M, Ostrowski P, Bednarz W, Wojciechowski W, Walocha J, Koziej M. Synovial plica of the elbow detailed measurements and how to implicate its relevance in clinical practice. Int Orthop. 2023;47(4):1031–9.