Elbow synovial fold syndrome refers to a condition where patients experience a cluster of symptoms due to the presence of synovial folds (also known as synovial fringe or plicae).
It tends to be more common in athletic young adults. It is associated with certain sporting activities which require repetitive flexion-extension (e.g. tennis, golf) and other sports that involve throwing.
Patients tend to present with snapping pain and/or elbow locking during elbow flexion and extension.
A normal synovial fold is seen a hyperechoic triangular-shaped structure surrounded by a thin hypoechoic ring. Pathologic synovial folds often appear thickened on ultrasound, with irregular echogenicity and margins.
Best assessed on fluid-sensitive sequences. Normal synovial folds are seen as hypointense bands surrounded by synovial fluid. Some authors have suggested a 3 mm cut-off for differentiating thickened elbow folds versus normal. A nodular or irregular appearance has been associated with symptomatic plicae.
MRI may also show secondary signs of elbow synovial fold syndrome:
- existence of focal posterolateral synovitis and chondromalacia in the anterolateral aspect of the radial head or, less frequently, on the capitellum
- chondromalacia is secondary to the chronic mechanical snapping of the synovial folds over the surface
T1C+ (Gd): may allow detection of associated synovitis (an important secondary sign of elbow synovial fold syndrome) although this may not be present in chronic cases.
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