Skeletal Radiology

, Volume 42, Issue 5, pp 675–680 | Cite as

Elbow MR imaging findings in patients with synovial fringe syndrome

  • Brian C. Ruiz de Luzuriaga
  • Clyde A. Helms
  • Andrzej S. Kosinski
  • Emily N. VinsonEmail author
Scientific Article



To describe imaging findings in patients with synovial fringe (SF) syndrome of the elbow and to compare with a control population.

Materials and methods

Nine patients (5 men, 4 women) whose mean age was 35.7 years were diagnosed with SF syndrome and had undergone preoperative elbow MRI. The radiohumeral (RH) plica was assessed for thickness, cross-sectional area, coverage of one third or more of the radial head, blunting of the free edge, and T2 signal intensity abnormality. Other abnormalities of the RH joint were also assessed, including adjacent articular cartilage defects, subcortical bone marrow signal abnormality in the capitellum, and synovitis. Results were compared with 15 control patients who were asymptomatic laterally and posteriorly.


Mean thickness and cross-sectional area of the RH plica were 1.8 mm and 19.4 mm2 respectively in controls, compared with 2.5 mm and 21.9 mm2 respectively in symptomatic patients. No statistically significant differences in the distribution of the mean thickness or cross-sectional area of the RH plica were found between the two groups. However, 67% of SF syndrome patients had a RH plica thickness greater than 2.6 mm compared with only 13% of controls (p = 0.021). Other abnormalities of the RH plica occurred more frequently in patients with SF syndrome compared with controls, but were not statistically significant.


In patients presenting with posterolateral pain or mechanical symptoms in the elbow, RH plica thickness greater than 2.6 mm on elbow MRI examinations may help identify patients with SF syndrome.


Elbow MRI Synovial fringe syndrome Radiohumeral plica 


  1. 1.
    Clarke RP. Symptomatic, lateral synovial fringe (plica) of the elbow joint. Arthroscopy. 1988;4(2):112–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Ruch DS, Papadonikolakis A, Campolattaro RM. The posterolateral plica: a cause of refractory lateral elbow pain. J Shoulder Elbow Surg. 2006;15(3):367–70.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedGoogle Scholar
  4. 4.
    Akagi M, Nakamura T. Snapping elbow caused by the synovial fold in the radiohumeral joint. J Shoulder Elbow Surg. 1998;7(4):427–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Antuna SA, O’Driscoll SW. Snapping plicae associated with radiocapitellar chondromalacia. Arthroscopy. 2001;17(5):491–5.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    Steinert AF, Goebel S, Rucker A, Barthel T. Snapping elbow caused by hypertrophic synovial plica in the radiohumeral joint: a report of three cases and review of literature. Arch Orthop Trauma Surg. 2010;130(3):347–51.PubMedCrossRefGoogle Scholar
  8. 8.
    Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M. Ligaments and plicae of the elbow: normal MR imaging variability in 60 asymptomatic subjects. Radiology. 2010;257(1):185–94.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 10.
    Huang GS, Lee CH, Lee HS, Chen CY. A meniscus causing painful snapping of the elbow joint: MR imaging with arthroscopic and histologic correlation. Eur Radiol. 2005;15(12):2411–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Fukase N, Kokubu T, Fujioka H, Iwama Y, Fujii M, Kurosaka M. Usefulness of MRI for diagnosis of painful snapping elbow. Skeletal Radiol. 2006;35(10):797–800.PubMedCrossRefGoogle Scholar
  12. 12.
    Sanghi A, Ly JQ, Bush RJ, Folio LR. Case for diagnosis. Elbow synovial fold syndrome. Mil Med. 2007;172(12):xii–xiii.PubMedGoogle Scholar
  13. 13.
    Kotnis NA, Chiavaras MM, Harish S. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol. 2012;41(4):369–86.PubMedCrossRefGoogle Scholar
  14. 14.
    Meyers AB, Kim HK, Emery KH. Elbow plica syndrome: presenting with elbow locking in a pediatric patient. Pediatr Radiol. 2012; doi: 10.1007/s00247-012-2407-1.Google Scholar
  15. 15.
    Merida-Velasco JA, Sanchez-Montesinos I, Espin-Ferra J, Merida-Velasco JR, Rodriguez-Vazquez JF, Jimenez-Collado J. Development of the human elbow joint. Anat Rec. 2000;258(2):166–75.PubMedCrossRefGoogle Scholar
  16. 16.
    Isogai S, Murakami G, Wada T, Ishii S. Which morphologies of synovial folds result from degeneration and/or aging of the radiohumeral joint: an anatomic study with cadavers and embryos. J Shoulder Elbow Surg. 2001;10(2):169–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Duparc F, Putz R, Michot C, Muller JM, Freger 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.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2012

Authors and Affiliations

  • Brian C. Ruiz de Luzuriaga
    • 1
  • Clyde A. Helms
    • 1
  • Andrzej S. Kosinski
    • 2
  • Emily N. Vinson
    • 1
    Email author
  1. 1.Department of RadiologyDuke University Medical CenterDurhamUSA
  2. 2.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamUSA

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