Park Kun-Bo, Kim Sung-Jae, Chun Yong-Min, Yoon Tae-Hwan, Choi Yun Seok, Jung Min
The Department of Orthopaedic Surgery.
The Arthroscopy and Joint Research Institute, The Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2019 May;98(18):e15497. doi: 10.1097/MD.0000000000015497.
Synovial plica is rarely diagnosed as cause of elbow pain. Impingemnt of posterolateral plicae in the radiocapitellar joint tends to be usually overlooked. The purpose of this study was to present outcomes of arthroscopic treatment in relatively large number of cases and propose reliable diagnostic test for posterolateral plicae of the radiocapitellar joint.From January 2000 to December 2010, 24 cases diagnosed with pathologic posterolateral radiocapitellar plica on arthroscopic finding were retrospectively reviewed. Magnetic resonance imaging (MRI) evaluation and preoperative physical examination were performed. The posterolateral radiocapitellar plica test newly proposed by the present study was also conducted. To measure postoperative clinical outcomes, the disabilities of the arm, shoulder, and hand (DASH) score and Mayo elbow performance score (MEPS) were employed. Minimum duration of follow up was 24 months.According to the preoperative MRI, pathologic radiocapitellar plica was identified in 17 cases (70.8%). Preoperatively, maximal tender point was present on the radiocapitellar joint line in 20 cases (83.3%) and mechanical symptoms were observed in 9 cases (37.5%). 6 cases (25%) demonstrated pain at terminal extension and limitation of extension. 20 (83.3%) cases tested positive for posterolateral radiocapitellar plica test. The sensitivity and specificity of the posterolateral radiocapitellar plica test were 83.3% and 87.5%, respectively. The accuracy value was 86.3%. Arthroscopic debridement of pathologic plica in the radiocapitellar joint demonstrated clinical improvements: DASH score was from 36.6 to 8.9 and MEPS was from 56.9 to 95.6 at the latest follow-up.Symptomatic impingement by the pathologic posterolateral plica of the radiocapitellar joint should be considered when posterolateral elbow pain which is refractory to conservative treatment, and other prevalent diseases are excluded. The posterolateral radiocapitellar plica test and radiocapitellar joint line tenderness could be recommended as reliable examination maneuvers to obtain accurate diagnosis. Arthroscopic debridement was an effective method for treating symptomatic plicae.
滑膜皱襞很少被诊断为肘部疼痛的原因。桡骨头关节后外侧皱襞的撞击往往容易被忽视。本研究的目的是展示相对大量病例的关节镜治疗结果，并为桡骨头关节后外侧皱襞提出可靠的诊断测试。从2000年1月至2010年12月，对24例经关节镜检查发现患有病理性桡骨头关节后外侧皱襞的病例进行回顾性分析。进行了磁共振成像（MRI）评估和术前体格检查。还进行了本研究新提出的桡骨头关节后外侧皱襞测试。为了评估术后临床结果，采用了手臂、肩部和手部功能障碍（DASH）评分和梅奥肘关节功能评分（MEPS）。最短随访时间为24个月。根据术前MRI，17例（70.8%）发现病理性桡骨头皱襞。术前，20例（83.3%）在桡骨头关节线上有最大压痛点，9例（37.5%）观察到机械性症状。6例（25%）表现为终末伸展时疼痛和伸展受限。20例（83.3%）桡骨头关节后外侧皱襞测试呈阳性。桡骨头关节后外侧皱襞测试的敏感性和特异性分别为83.3%和87.5%。准确性值为86.3%。桡骨头关节病理性皱襞的关节镜下清创显示临床症状改善：最新随访时DASH评分从36.6降至8.9，MEPS评分从56.9升至95.6。当保守治疗无效的肘关节后外侧疼痛且排除其他常见疾病时，应考虑病理性桡骨头关节后外侧皱襞引起的症状性撞击。桡骨头关节后外侧皱襞测试和桡骨头关节线压痛可作为获得准确诊断的可靠检查手段。关节镜下清创是治疗有症状皱襞的有效方法。
