Skip to main content
SpringerLink
Log in

Snapping of the annular ligament: a uncommon injury characterised by snapping or locking of the elbow with good surgical outcomes

  • Elbow
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

WMO:

Medical research involving human subjects act

MEPI:

Mayo Elbow Performance Index

OES:

Oxford Elbow Score

PRU:

Proximal radiohumeral joint

ALR:

Annular ligament reconstruction

RAL:

Resection of the annular ligament

95% CI:

95% confidence interval

References

  1. Aoki M, Okamura K, Yamashita T (2003) Snapping annular ligament of the elbow joint in the throwing arms of young brothers. Arthroscopy 19(8):e89–e92

    Article  Google Scholar 

  2. Bjerre JJ, Johannsen FE, Rathcke M, Krogsgaard MR (2018) Snapping elbow-A guide to diagnosis and treatment. World J Orthop 9:65–71

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bozentka DJ (2000) Subluxation of the annular ligament as a cause of elbow clicking. J Shoulder Elb Surg 9:67–69

    Article  CAS  Google Scholar 

  4. Chai JW, Kim S, Lim HK, Bae KJ (2014) Ultrasonographic diagnosis of snapping annular ligament in the elbow. Ultrasonography 34:71–73

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dawson J, Doll H, Boller I, Fitzpatrick R, Little C, Rees J, Jenkinson C, Carr AJ (2008) The development and validation of a patient- reported questionnaire to assess outcomes of elbow surgery. J Bone Jt Surg Br 90:466–473

    Article  CAS  Google Scholar 

  6. de Haan J, Goei H, Schep NWL, Tuinebreijer WE, Patka P, den Hartog D (2011) The reliability, validity and responsiveness of the Dutch version of the Oxford elbow score. J Orthop Surg Res 6:39

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hackl M, Wegmann K, Ries C, Lappen S, Scaal M, Müller LP (2017) Annular ligament reconstruction with the superficial head of the brachialis: surgical technique and biomechanical evaluation. Surg Radiol Anat 39:585–591

    Article  PubMed  Google Scholar 

  8. Huang GS, Lee CH, Lee HS, Chen CY (2005) MRI, arthroscopy, and histologic observations of an annular ligament causing painful snapping of the elbow joint. Am J Roentgenol 185:397–399

    Article  Google Scholar 

  9. Kang ST, Kim TH (2010) Lateral sided snapping elbow caused by a meniscus: two case reports and literature review. Knee Surg Sport Traumatol Arthrosc 18:840–844

    Article  Google Scholar 

  10. Longo UG, Franceschi F, Loppini M, Maffulli N, Denaro V (2008) Rating systems for evaluation of the elbow. Br Med Bull 87:131–161

    Article  PubMed  Google Scholar 

  11. Marinello PG, Wagner T, Styron J, Maschke S, Evans PJ (2016) Annular ligament reconstruction with triceps autograft for chronic radial head instability. Tech Hand Up Extrem Surg 20:21–25

    Article  PubMed  Google Scholar 

  12. Maruyama M, Takahara M, Kikuchi N, Ito K, Watanabe T, Ogino T (2010) Snapping elbow with congenital radial head dislocation: case report. J Hand Surg Am 35:981–985

    Article  PubMed  Google Scholar 

  13. Nwoko OE, Patel PP, Richard MJ, Leversedge FJ (2013) Annular ligament reconstruction using the distal tendon of the superficial head of the brachialis muscle: an anatomical feasibility study. J Hand Surg Am 38:1315–1319

    Article  PubMed  Google Scholar 

  14. Wightman JAK (1963) Clicking elbow from a torn annular ligament. J Bone Jt Surg 45B:380–381

    Article  Google Scholar 

Download references

Acknowledgements

The Oxford and Isis Outcomes, part of Isis Innovation Limited, gave permission to use the Oxford Elbow Score, and we thank them for their kind support. We would especially like to thank A.J. de Vries for her contributions in reviewing this article.

Disclaimer

None.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Martini Hospital, Postbus 30033, 9700 RM, Groningen, The Netherlands

    Nienke Kerver, Ashvin V. Boeddha & Carina L. E. Gerritsma-Bleeker

  2. Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands

    Denise Eygendaal

  3. Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    Denise Eygendaal

Authors
  1. Nienke Kerver
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashvin V. Boeddha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carina L. E. Gerritsma-Bleeker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Denise Eygendaal
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NK did the data acquisition, analysis and drafting of the manuscript. AB participated in the design and coordination of the study and helped draft the manuscript. CG and DE revised the manuscript, selected potential suitable patients for the study and also participated in the coordination of the study. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Nienke Kerver.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests (see signed forms in attachment).

Ethical committee approval

The regional Medical Ethical Committee evaluated the protocol for this study. The Medical Research Involving Human Subjects Act (WMO) did not apply. This study is registered under No. RTPO 986a with the Institutional Review Board Regionale Toetsingscommissie Patiëntgebonden Onderzoek (RTPO), Zorgpartners Friesland.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kerver, N., Boeddha, A.V., Gerritsma-Bleeker, C.L.E. et al. 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 27, 326–333 (2019). https://doi.org/10.1007/s00167-018-5076-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-5076-2

Keywords

Search

Navigation