Elbow plica syndrome is a relatively uncommon condition that can cause significant discomfort and functional limitations, particularly in individuals who engage in repetitive arm movements. This blog describes what elbow plica syndrome is, its symptoms, investigations, and management strategies.
What is an Elbow Plica?
The elbow joint is surrounded by a synovial membrane that produces a lubricating fluid. In some individuals, a fold of this synovial tissue can thicken, leading to a plica. Although we do not know for sure, we think plicas provide cushioning to the joint and help distribute joint fluid.
Sometimes, with repetitive movements or trauma, the plica can become inflamed, resulting in pain and mechanical symptoms, also known as elbow plica syndrome.
Symptoms
Patients with elbow plica syndrome often present with the following:
- Localised Pain: Discomfort is more common on the outer part of the elbow. Symptoms are often worse with repetitive arm movement such as pushing, lifting or throwing.
- Mechanical Symptoms: Clicking, catching, or locking sensations during elbow movement, particularly with the wrist turned inwards (pronation).
- Swelling: Mild swelling around the elbow joint in some cases.
- Reduced Range of Motion: Difficulty fully extending or flexing the elbow.
Imaging helps define an abnormal elbow plica:
- MRI is good at visualising soft tissue abnormalities, including thickened or inflamed plicae. Generally, abnormal symptomatic plicas are thicker and more extensive than normal plicas. Studies suggest that a plica larger than 3mm is more likely to be symptomatic.
- Ultrasound: Useful for dynamic assessment and identifying synovial thickening or snapping of the plica.
Elbow Plica Syndrome Management
Treatment focuses on reducing inflammation, alleviating symptoms, and restoring function. Management options include:
Conservative Treatment
- Rest and Activity Modification
- Avoid activities that exacerbate your symptoms, particularly repetitive motions, until they subside.
- Physical Therapy
- Focused on improving elbow mobility and strengthening surrounding muscles.
- Techniques to reduce stress on the joint and improve biomechanics can help with symptoms.
- Medications
- Non-steroidal anti-inflammatory drugs (NSAIDS) can help reduce pain and inflammation.
- Injections
- Corticosteroid injections into the plica and joint can temporarily relieve inflammation and help confirm a diagnosis of elbow plica. Generally, injections should be done with ultrasound guidance to improve accuracy and effectiveness.
Surgical Treatment
For cases that do not respond to conservative measures, athletes may require arthroscopic surgery. This minimally invasive procedure involves removing the inflamed synovial fold to alleviate symptoms.
Other commonly asked questions about the Elbow Plica
What causes the plica to become inflamed and painful?
We think that direct trauma from a fall or hit to the elbow or repetitive flexion and extension movement from sports such as golf or tennis can inflame the plica, causing pain and mechanical symptoms.
Who commonly develops a painful plica in the elbow?
Generally, we see painful elbow plica in young athletic adults who participate in sports such as tennis, golf, and other throwing sports.
What other elbow conditions mimic symptoms of plica of the elbow?
Other elbow conditions that need to be excluded include tennis elbow, elbow joint arthritis, radial tunnel syndrome, triceps snapping syndrome, medial collateral ligament sprain, and posterolateral elbow joint instability.
Final word from Sportdoctorlondon about Plica in the elbow
Elbow plica syndrome, although uncommon, should be considered in individuals presenting with persistent elbow pain and mechanical symptoms, particularly in athletes or those with repetitive arm use. Early diagnosis and management can lead to excellent outcomes. If you think you have this condition, consult a sports medicine doctor for an early diagnosis and individualised treatment plan.
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