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).
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Epidemiology
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.
Clinical presentation
Patients tend to present with snapping pain and/or elbow locking during elbow flexion and extension.
Radiographic features
Ultrasound
A normal synovial fold is seen as a hyperechoic triangular-shaped structure surrounded by a thin hypoechoic ring. Pathologic synovial folds often appear thickened on ultrasound, with irregular echogenicity and margins.
MRI
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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