Snapping elbow-A guide to diagnosis and treatment

Jonathan Jetsmark Bjerre; Finn Elkjær Johannsen; Martin Rathcke; Michael Rindom Krogsgaard

doi:10.5312/wjo.v9.i4.65

Snapping elbow-A guide to diagnosis and treatment

Jonathan Jetsmark Bjerre, Finn Elkjær Johannsen, Martin Rathcke, Michael Rindom Krogsgaard

Department of Clinical Medicine

6 Citations (Scopus)

Abstract

AIM To develop practical guidelines for diagnosis and treatment of the painful snapping elbow syndrome (SE). METHODS Clinical studies were searched in the databases PubMed and Scopus for the phrases "SE", "snapping triceps", "snapping ulnar nerve" and "snapping annular ligament". A total of 36 relevant studies were identified. From these we extracted information about number of patients, diagnostic methods, patho-anatomical findings, treatments and outcomes. Practical guidelines for diagnosis and treatment of SE were developed based on analysis of the data. We present two illustrative patient cases-one with intra-articular pathology and one with extra-articular pathology. RESULTS Snapping is audible, palpable and often visible. It has a lateral (intra-articular) or medial (extra-articular) pathology. Snapping over the medial humeral epicondyle is caused by dislocation of the ulnar nerve or a part of the triceps tendon, and is demonstrated by dynamic ultrasonography. Treatment is by open surgery. Lateral snapping over the radial head has an intra-articular pathology: A synovial plica, a torn annular ligament or a meniscus-like remnant from the foetal elbow. Pathology can be visualized by conventional arthrography, magnetic resonance (MR) arthrography, high resolution magnetic resonance imaging (MRI) and arthroscopy, while conventional MRI and radiographs often turn out normal. Treatment is by arthroscopic or eventual open resection. Early surgical intervention is recommended as the snapping can damage the ulnar nerve (medial) or the intra-articular cartilage (lateral). If medial snapping only occurs during repeated or loaded extension/flexion of the elbow (in sports or work) it may be treated by reduction of these activities. Differential diagnoses are loose bodies (which can be visualized by radiographs) and postero-lateral instability (demonstrates by clinical examination). An algorithm for diagnosis and treatment is suggested. CONCLUSION The primary step is establishment of laterality. From this follows relevant diagnostic measures and treatment as defined in this guideline.

Original language	English
Journal	World Journal of Orthopedics
Volume	9
Issue number	4
Pages (from-to)	65-71
ISSN	2218-5836
DOIs	https://doi.org/10.5312/wjo.v9.i4.65
Publication status	Published - 18 Apr 2018

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title = "Snapping elbow-A guide to diagnosis and treatment",

abstract = "AIM To develop practical guidelines for diagnosis and treatment of the painful snapping elbow syndrome (SE). METHODS Clinical studies were searched in the databases PubMed and Scopus for the phrases {"}SE{"}, {"}snapping triceps{"}, {"}snapping ulnar nerve{"} and {"}snapping annular ligament{"}. A total of 36 relevant studies were identified. From these we extracted information about number of patients, diagnostic methods, patho-anatomical findings, treatments and outcomes. Practical guidelines for diagnosis and treatment of SE were developed based on analysis of the data. We present two illustrative patient cases-one with intra-articular pathology and one with extra-articular pathology. RESULTS Snapping is audible, palpable and often visible. It has a lateral (intra-articular) or medial (extra-articular) pathology. Snapping over the medial humeral epicondyle is caused by dislocation of the ulnar nerve or a part of the triceps tendon, and is demonstrated by dynamic ultrasonography. Treatment is by open surgery. Lateral snapping over the radial head has an intra-articular pathology: A synovial plica, a torn annular ligament or a meniscus-like remnant from the foetal elbow. Pathology can be visualized by conventional arthrography, magnetic resonance (MR) arthrography, high resolution magnetic resonance imaging (MRI) and arthroscopy, while conventional MRI and radiographs often turn out normal. Treatment is by arthroscopic or eventual open resection. Early surgical intervention is recommended as the snapping can damage the ulnar nerve (medial) or the intra-articular cartilage (lateral). If medial snapping only occurs during repeated or loaded extension/flexion of the elbow (in sports or work) it may be treated by reduction of these activities. Differential diagnoses are loose bodies (which can be visualized by radiographs) and postero-lateral instability (demonstrates by clinical examination). An algorithm for diagnosis and treatment is suggested. CONCLUSION The primary step is establishment of laterality. From this follows relevant diagnostic measures and treatment as defined in this guideline.",

author = "Bjerre, {Jonathan Jetsmark} and Johannsen, {Finn Elkj{\ae}r} and Martin Rathcke and Krogsgaard, {Michael Rindom}",

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doi = "10.5312/wjo.v9.i4.65",

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TY - JOUR

T1 - Snapping elbow-A guide to diagnosis and treatment

AU - Bjerre, Jonathan Jetsmark

AU - Johannsen, Finn Elkjær

AU - Rathcke, Martin

AU - Krogsgaard, Michael Rindom

PY - 2018/4/18

Y1 - 2018/4/18

N2 - AIM To develop practical guidelines for diagnosis and treatment of the painful snapping elbow syndrome (SE). METHODS Clinical studies were searched in the databases PubMed and Scopus for the phrases "SE", "snapping triceps", "snapping ulnar nerve" and "snapping annular ligament". A total of 36 relevant studies were identified. From these we extracted information about number of patients, diagnostic methods, patho-anatomical findings, treatments and outcomes. Practical guidelines for diagnosis and treatment of SE were developed based on analysis of the data. We present two illustrative patient cases-one with intra-articular pathology and one with extra-articular pathology. RESULTS Snapping is audible, palpable and often visible. It has a lateral (intra-articular) or medial (extra-articular) pathology. Snapping over the medial humeral epicondyle is caused by dislocation of the ulnar nerve or a part of the triceps tendon, and is demonstrated by dynamic ultrasonography. Treatment is by open surgery. Lateral snapping over the radial head has an intra-articular pathology: A synovial plica, a torn annular ligament or a meniscus-like remnant from the foetal elbow. Pathology can be visualized by conventional arthrography, magnetic resonance (MR) arthrography, high resolution magnetic resonance imaging (MRI) and arthroscopy, while conventional MRI and radiographs often turn out normal. Treatment is by arthroscopic or eventual open resection. Early surgical intervention is recommended as the snapping can damage the ulnar nerve (medial) or the intra-articular cartilage (lateral). If medial snapping only occurs during repeated or loaded extension/flexion of the elbow (in sports or work) it may be treated by reduction of these activities. Differential diagnoses are loose bodies (which can be visualized by radiographs) and postero-lateral instability (demonstrates by clinical examination). An algorithm for diagnosis and treatment is suggested. CONCLUSION The primary step is establishment of laterality. From this follows relevant diagnostic measures and treatment as defined in this guideline.

AB - AIM To develop practical guidelines for diagnosis and treatment of the painful snapping elbow syndrome (SE). METHODS Clinical studies were searched in the databases PubMed and Scopus for the phrases "SE", "snapping triceps", "snapping ulnar nerve" and "snapping annular ligament". A total of 36 relevant studies were identified. From these we extracted information about number of patients, diagnostic methods, patho-anatomical findings, treatments and outcomes. Practical guidelines for diagnosis and treatment of SE were developed based on analysis of the data. We present two illustrative patient cases-one with intra-articular pathology and one with extra-articular pathology. RESULTS Snapping is audible, palpable and often visible. It has a lateral (intra-articular) or medial (extra-articular) pathology. Snapping over the medial humeral epicondyle is caused by dislocation of the ulnar nerve or a part of the triceps tendon, and is demonstrated by dynamic ultrasonography. Treatment is by open surgery. Lateral snapping over the radial head has an intra-articular pathology: A synovial plica, a torn annular ligament or a meniscus-like remnant from the foetal elbow. Pathology can be visualized by conventional arthrography, magnetic resonance (MR) arthrography, high resolution magnetic resonance imaging (MRI) and arthroscopy, while conventional MRI and radiographs often turn out normal. Treatment is by arthroscopic or eventual open resection. Early surgical intervention is recommended as the snapping can damage the ulnar nerve (medial) or the intra-articular cartilage (lateral). If medial snapping only occurs during repeated or loaded extension/flexion of the elbow (in sports or work) it may be treated by reduction of these activities. Differential diagnoses are loose bodies (which can be visualized by radiographs) and postero-lateral instability (demonstrates by clinical examination). An algorithm for diagnosis and treatment is suggested. CONCLUSION The primary step is establishment of laterality. From this follows relevant diagnostic measures and treatment as defined in this guideline.

U2 - 10.5312/wjo.v9.i4.65

DO - 10.5312/wjo.v9.i4.65

M3 - Journal article

C2 - 29686971

SN - 2218-5836

VL - 9

SP - 65

EP - 71

JO - World Journal of Orthopedics

JF - World Journal of Orthopedics

IS - 4

ER -

Snapping elbow-A guide to diagnosis and treatment

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