Snapping Plicae Associated with Radiocapitellar Chondromalacia

Author(s): Antuna SA, O'Driscoll SW

Source: Journal of Arthroscopic and Related Surgery


This is a retrospective review of 14 patients who presented with a painful snapping of the elbow joint. Arthroscopic evaluation revealed a large radiocapitellar plica in each case. The arthroscopic procedure involved excision of the plica through the anterolateral portal. The clinical results demonstrated 12 of 14 patients with complete relief of their symptoms. One failure was to due to posterolateral rotatory instability and one due to recurrence. The authors describe the arthroscopic findings as an anterior synovial plica that slips between the radiocapitellar joint with elbow flexion. The authors further postulate that the patient's symptoms are secondary to the presence of small nerves in the plica that reproduce symptoms similar to tennis elbow.

This report describes another, albeit rare, cause of painful mechanical symptoms about the elbow. All of the patients reported had previous diagnoses that included radial head fracture, epicondylitis, posterior interosseous nerve compression and loose body formation. The radiographs were normal in all patients and MRI findings were normal in 5 of 6 patients (one patient demonstrated mild edema of the annular ligament). The authors indicate that the diagnosis can be made by reproducing the patient's symptoms by passively flexing the pronated elbow, which they refer to as the "flexion-pronation test".