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Cho CH, Lim KH, Kim DH. Bilateral snapping triceps syndrome: A case report. World J Clin Cases 2023; 11:8228-8234. [PMID: 38130777 PMCID: PMC10731183 DOI: 10.12998/wjcc.v11.i34.8228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Snapping triceps syndrome (STS) is a rare disease, while occurrence of bilateral STS is extremely rare. It is usually accompanied by dislocation of the ulnar nerve and double snapping is a clinically important feature. However, to the best of our knowledge, there has been no report of bilateral STS in young active patient. CASE SUMMARY A 23-year-old male presented with a complaint of discomfort and snapping on the medial side of both elbows while performing push-ups. On physical examination, two distinct snaps that were both palpable and audible were detected on additional clinical examination. Dynamic ultrasonography showed that the ulnar nerve and the medial head of the triceps were dislocated anteriorly over the medial epicondyle of the elbow during flexion motion. Finally, he was diagnosed as dislocation of the ulnar nerve and STS. Staged anterior subcutaneous transposition of the ulnar nerve combined with partial resection of the snapping portion of the triceps was performed. The patient's pain and snapping symptoms were resolved immediately after surgery. Three months later, the patient was completely asymptomatic and returned to normal activity. CONCLUSION STS should be included in the differential diagnosis for active young patients who present with painful snapping on the medial side of the elbow joint, particularly when dislocation of the ulnar nerve is detected. Dynamic sonography is used to assist in accurate diagnosis and differentiation between isolated dislocation of the ulnar nerve and STS.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
| | - Kyung-Hwan Lim
- Orthopedic Surgery, Allright Hospital, Daegu 42038, South Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
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Romero JM, Hasley IB, Johnson SE. Nineteen-Year-Old Male With Left Elbow Discomfort. Am J Phys Med Rehabil 2023; 102:e156-e157. [PMID: 37026853 DOI: 10.1097/phm.0000000000002254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Joshua M Romero
- From the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (JMR); Department of Physical Medicine and Rehabilitation, Mayo Clinic, Minneapolis, Minnesota (IH); and Department of Orthopedic Surgery, Division of Sports Medicine, Mayo Clinic, Minnesota (SJ)
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3
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Pirri C, Pirri N, Stecco C, Macchi V, Porzionato A, De Caro R, Özçakar L. Hearing and Seeing Nerve/Tendon Snapping: A Systematic Review on Dynamic Ultrasound Examination. SENSORS (BASEL, SWITZERLAND) 2023; 23:6732. [PMID: 37571516 PMCID: PMC10422582 DOI: 10.3390/s23156732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Nerve/tendon snapping can occur due to their sudden displacement during the movement of an adjacent joint, and the clinical condition can really be painful. It can actually be challenging to determine the specific anatomic structure causing the snapping in various body regions. In this sense, ultrasound examination, with all its advantages (especially providing dynamic imaging), appears to be quite promising. To date, there are no comprehensive reviews reporting on the use of dynamic ultrasound examination in the diagnosis of nerve/tendon snapping. Accordingly, this article aims to provide a substantial discussion as to how US examination would contribute to 'seeing' and 'hearing' these pathologies' different maneuvers/movements.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Nina Pirri
- Department of Medicine—DIMED, School of Radiology, Radiology Institute, University of Padua, 35122 Padova, Italy;
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey;
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4
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Kameda K, Miyatake K, Fujisawa T, Otoshi A, Kawabata Y, Kusaba Y, Inaba Y. Dynamic sonographic diagnosis of snapping elbow associated with congenital radioulnar synostosis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:116-119. [PMID: 37588070 PMCID: PMC10426716 DOI: 10.1016/j.xrrt.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Kensuke Kameda
- Department of Orthopedic Surgery, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Kazuma Miyatake
- Department of Orthopedic Surgery, Yokohama City University Hospital, Kanagawa, Japan
| | - Takahiro Fujisawa
- Department of Orthopedic Surgery, Yokohama City University Hospital, Kanagawa, Japan
| | - Akio Otoshi
- Department of Orthopedic Surgery, Odawara Municipal Hospital, Kanagawa, Japan
| | - Yusuke Kawabata
- Department of Orthopedic Surgery, Yokohama City University Hospital, Kanagawa, Japan
| | - Yohei Kusaba
- Department of Orthopedic Surgery, Yokohama City University Hospital, Kanagawa, Japan
| | - Yutaka Inaba
- Department of Orthopedic Surgery, Yokohama City University Hospital, Kanagawa, Japan
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Ricci V, Güvener O, Chang KV, Wu WT, Mezian K, Kara M, Leblebicioğlu G, Pirri C, Ata AM, Dughbaj M, Jain NB, Stecco C, Özçakar L. EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Elbow. Am J Phys Med Rehabil 2022; 101:e83-e92. [PMID: 34930863 DOI: 10.1097/phm.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In this dynamic protocol, ultrasound examination of the elbow using different maneuvers is described for several/relevant elbow problems. Scanning videos are coupled with real-time patient examination videos for better understanding. The authors believe that this practical guide-prepared by an international consensus of several experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine])-will help musculoskeletal physicians perform a better and uniform/standard approach.
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Affiliation(s)
- Vincenzo Ricci
- From the Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy (VR); Department of Physical and Rehabilitation Medicine, Mersin University Medical School, Mersin, Turkey (OG); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan (K-VC, W-TW); National Taiwan University College of Medicine, Taipei, Taiwan (K-VC); Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic (KM); Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, LÖ); The Hand Clinic, Ankara, Turkey (GL); Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy (CP, CS); Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey (AMA); Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait City, Kuwait (MD); and Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population and Data Sciences, University of Texas Southwestern, Dallas, Texas (NBJ)
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Thiele K, Akgün D, Al-Mutaresh F, Stöckle U, Lacheta L, Moroder P. Technical Note: Arthroscopic Resection of Snapping, Interponating Annular Ligament of the Elbow. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021. [PMID: 34937101 DOI: 10.1055/a-1658-1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The indication for surgical treatment of lateral snapping elbow syndrome is recurrent joint blockage in combination with pain of the affected elbow joint. Different parts of the lateral synovial capsule sleeve complex, including the annular ligament itself, a hypertrophic synovial fold, or meniscus-like soft tissue interposition can lead to painful entrapment. Surgical treatment options can include an arthroscopic or open procedure. The aim of this technical note is to provide a step-by-step illustration of the authors' preferred arthroscopic approach with a comprehensive review of literature on clinical outcome.
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Affiliation(s)
- Kathi Thiele
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Germany
| | - Doruk Akgün
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Germany
| | - Faisal Al-Mutaresh
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Germany
| | - Ulrich Stöckle
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Germany
| | - Lucca Lacheta
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Germany
| | - Philipp Moroder
- Centrum für Muskuloskeletale Chirurgie, Charité Universitätsmedizin Berlin, Germany
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Edelmuth DGL, Helito PVP, Correa MFDP, Bordalo-Rodrigues M. Acute Ligament Injuries of the Elbow. Semin Musculoskelet Radiol 2021; 25:580-588. [PMID: 34706388 DOI: 10.1055/s-0041-1729959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ulnar collateral, radial collateral, lateral ulnar collateral, and annular ligaments can be injured in an acute trauma, such as valgus stress in athletes and elbow dislocation. Recognizing normal anatomy in magnetic resonance imaging and ultrasonography studies is important to identify ligamentous abnormalities in these imaging modalities.
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Affiliation(s)
- Diogo Guilherme Leão Edelmuth
- Radiology Department - Hospital Sirio Libanes, São Paulo, Brazil.,Radiology Department - Orthopedic Institute - Clinics Hospital - University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Victor Partezani Helito
- Radiology Department - Hospital Sirio Libanes, São Paulo, Brazil.,Radiology Department - Orthopedic Institute - Clinics Hospital - University of São Paulo Medical School, São Paulo, Brazil
| | | | - Marcelo Bordalo-Rodrigues
- Radiology Department - Hospital Sirio Libanes, São Paulo, Brazil.,Radiology Department - Orthopedic Institute - Clinics Hospital - University of São Paulo Medical School, São Paulo, Brazil
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Abstract
Triceps tendon injuries are an uncommon clinical entity poorly described in the literature. This review discusses the spectrum of pathology, effective diagnosis, nonsurgical treatment, surgical treatment, rehabilitation, and surgical complications of triceps tendon injuries. Management of triceps tendinopathies depends on the mechanism of injury and the patient's motor examination. Triceps tendinopathies and partial tendon tears with intact strength can be managed conservatively with rest, ice, immobilization, nonsteroidal anti-inflammatory drugs, and physical therapy. If conservative management fails for 6 months or there are strength deficits on examination, surgery should be considered. Based on the current evidence, there are no clear guidelines for "best" surgical approach. Although rare, the most significant surgical complication to be concerned about is rerupture. Rerupture rate is 4.62% among the articles we reviewed.
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Affiliation(s)
- Kyle Casadei
- Henry Ford Health System, Michigan, Lake Orion, MI
| | - John Kiel
- Emergency Medicine and Sports Medicine, University of Florida-Jacksonville College of Medicine, Jacksonville, FL
| | - Michael Freidl
- Orthopedic Surgery, University of Florida-Jacksonville College of Medicine, Jacksonville, FL
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Lubiatowski P, Wałecka J, Dzianach M, Stefaniak J, Romanowski L. Synovial plica of the elbow and its clinical relevance. EFORT Open Rev 2020; 5:549-557. [PMID: 33072407 PMCID: PMC7528666 DOI: 10.1302/2058-5241.5.200027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A synovial plica (fold) is normal anatomic finding, and occurs in 86–100% of cases; however, symptomatic plica is much less common (7.2–8.7% of all elbow arthroscopies). Synovial plica syndrome is a painful elbow condition related to symptomatic synovial plica. Synovial plica syndrome is diagnosed by clinical examination (lateral elbow pain) commonly accompanied by local tenderness, pain at terminal extension and/or painful snapping. Synovial plica syndrome may be mimicked by other elbow conditions, commonly tennis elbow, loose bodies, and degenerative arthritis. Magnetic resonance imaging or ultrasound scan may support diagnosis in correlation with clinical findings, but symptomatic plica may also be diagnosed as unexpected during elbow arthroscopy. The arthroscopic resection is effective and safe if conservative treatment fails.
Cite this article: EFORT Open Rev 2020;5:549-557. DOI: 10.1302/2058-5241.5.200027
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Affiliation(s)
- Przemysław Lubiatowski
- Sport Trauma and Biomechanics Unit, University of Medical Sciences, Poznań, Poland.,Rehasport Clinic, Poznań, Poland.,Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences, Poznań, Poland
| | - Joanna Wałecka
- Sport Trauma and Biomechanics Unit, University of Medical Sciences, Poznań, Poland.,Rehasport Clinic, Poznań, Poland.,Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences, Poznań, Poland
| | | | - Jakub Stefaniak
- Sport Trauma and Biomechanics Unit, University of Medical Sciences, Poznań, Poland.,Rehasport Clinic, Poznań, Poland.,Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences, Poznań, Poland
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences, Poznań, Poland
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10
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Sasaki A, Honnami M, Mochizuki M. Traumatic medial luxation of the triceps brachii tendon with medial subluxation of the elbow joint in a dog. Vet Surg 2020; 49:1632-1640. [PMID: 33034920 DOI: 10.1111/vsu.13485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the surgical reduction of luxation of the triceps brachii tendon in a dog. ANIMAL One 2.5-year-old 2.58 kg castrated male toy poodle. STUDY DESIGN Clinical case report. METHODS The dog displayed intermittent, non-weight bearing lameness of the right forelimb for approximately 18 months before presenting at the veterinary medical center. Medial subluxation of the right elbow joint was detected by palpation. The Campbell test was consistent with an increased range of motion during supination. At ultrasonographic examination, medial luxation of the triceps brachii tendon was noted, whereas collateral ligaments appeared normal. No skeletal deformities were found on radiographs of the right forelimb. The luxation of the triceps brachii tendon was surgically corrected with antirotational suture, a stopper pin, medial retinaculum release, and imbrication of the lateral retinaculum. RESULTS The right triceps brachii tendon and elbow joint were successfully reduced. Gait returned to normal by 55 days postoperatively. No implant failure or recurrence were observed 3.5 years after surgery. CONCLUSION Surgical reduction of a luxation of the triceps brachii tendon in a dog resolved lameness and restored the range of motion of the affected elbow, leading to good long-term outcome.
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Affiliation(s)
- Akari Sasaki
- Laboratory of Veterinary Emergency Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Muneki Honnami
- Veterinary Medical Centre, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Manabu Mochizuki
- Laboratory of Veterinary Emergency Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.,Veterinary Medical Centre, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
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11
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Imao K, Miwa H, Tsubokawa N, Maki Y, Endo N. Dislocation of the Medial Head of the Triceps With Ulnar Nerve Location Anterior to the Medial Epicondyle. J Hand Surg Am 2020; 45:72.e1-72.e4. [PMID: 31085093 DOI: 10.1016/j.jhsa.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/22/2019] [Accepted: 03/12/2019] [Indexed: 02/02/2023]
Abstract
Snapping elbow is a rare syndrome caused by dislocation of the medial head of the triceps. Simultaneous dislocation of the ulnar nerve occurs even less frequently. We report a case of ulnar nerve dislocation accompanied by dislocation of the triceps over the medial humeral epicondyle. The ulnar nerve was located in front of the medial epicondyle and did not change position with the elbow flexed or extended. At the point of insertion, the proximal end of the triceps muscle was displaced anteriorly. In this case, diagnosis by physical examination was challenging, but ultrasonography proved useful for diagnosis. During surgical treatment, partial resection of the triceps medial head was achieved, and the patient demonstrated a full recovery.
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Affiliation(s)
- Kanta Imao
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Department of Hand Surgery, Niigata Hand Surgery Foundation, Niigata, Japan; Department of Orthopedic Surgery, Niigata Prefectural Shibata Hospital, Niigata, Japan.
| | - Hitoshi Miwa
- Department of Hand Surgery, Niigata Hand Surgery Foundation, Niigata, Japan
| | - Naoto Tsubokawa
- Department of Orthopedic Surgery, Niigata Prefectural Shibata Hospital, Niigata, Japan
| | - Yutaka Maki
- Department of Orthopedic Surgery, Niigata Prefectural Shibata Hospital, Niigata, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Medial Epicondyle Fracture Leading to Snapping Elbow With Ulnar Neuropathy. Am J Phys Med Rehabil 2019; 98:e126-e127. [DOI: 10.1097/phm.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kerver N, Boeddha AV, Gerritsma-Bleeker CLE, Eygendaal D. Snapping of the annular ligament: a uncommon injury characterised by snapping or locking of the elbow with good surgical outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:326-333. [PMID: 30073382 DOI: 10.1007/s00167-018-5076-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Snapping annular ligament is an uncommon cause of lateral elbow pain. The purpose of this case series was to evaluate the clinical presentation and surgical outcomes for snapping annular ligament. METHODS Included were 23 patients with snapping annular ligament who received surgical treatment between 2007 and 2016. There were two treatment groups with either resection (arthroscopic or open procedure, n = 15) or open annular ligament reconstruction (n = 8). Patients were assessed with the Mayo Elbow Performance Index and the Oxford Elbow Score. Preoperative and postoperative scores were compared with a paired t test. RESULTS Pain was located laterally in nine patients (39.1%), anteriorly in three patients (13.0%), anterolaterally in two patients (8.7%), and diffusely in nine patients (39.1%). In total, 16 patients (69.6%) experienced a snapping sensation and ten patients (43.5%) locking of the elbow. According to the patients' reported outcomes, their symptoms improved significantly after both procedures. CONCLUSIONS This is the largest case series in the literature on snapping annular ligament, an uncommon cause of lateral elbow pain. Good treatment results are expected with resection of the interpositioned part of the annular ligament or annular ligament reconstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nienke Kerver
- Department of Orthopedic Surgery, Martini Hospital, Postbus 30033, 9700 RM, Groningen, The Netherlands.
| | - Ashvin V Boeddha
- Department of Orthopedic Surgery, Martini Hospital, Postbus 30033, 9700 RM, Groningen, The Netherlands
| | | | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
- Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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