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Arthroscopic Treatment of Posterolateral Elbow Impingement From Lateral Synovial Plicae in Throwing Athletes and Golfers

Authors: David H. Kim, Ralph A. Gambardella, Neal S. ElAttrache, Lewis A. Yocum, and Frank W. Jobe

References: Am J Sports Med 2006 34: 438-444

Abstract
Background: Although elbow pain is common in throwing athletes and golfers, posterolateral impingement from a hypertrophic synovial plica is a rare but possibly underdiagnosed condition.

Purpose: To evaluate the clinical results of arthroscopic treatment of symptomatic lateral elbow plicae in this athletic population.

Study Design: Case series; Level of evidence, 4.

Methods: Twelve patients, 9 male and 3 female, whose mean age was 21.6 years (range, 17–33 years), were reviewed. There were 7 baseball pitchers, 2 softball players, and 3 golfers. All patients had diagnosed isolated lateral elbow plica; none had lateral epicondylitis, instability, osteochondritis dissecans, arthritis, loose bodies, or nerve conditions. The mean time from onset of symptoms to treatment was 9.25 months (range, 3–24.5 months). At a mean follow-up of 33.8 months (range, 24–65.5 months), patients were evaluated with a questionnaire and examination, based on the American Shoulder and Elbow Surgeons standardized elbow assessment and previously reported elbow outcome score.

Results: Posterolateral elbow pain was present in all patients. Fifty-eight percent (7 of 12 patients) complained of clicking or catching, whereas only 25% (3 of 12) experienced swelling or effusion. At elbow arthroscopy, a thickened synovial lateral plica was debrided in all cases. Ninety-two percent (11 of 12 patients) reported an excellent outcome with a mean elbow score of 92.5 points (maximum, 100 points). Return to competitive play averaged 4.8 months (range, 3–9.5 months). One patient with a fair outcome developed medial elbow instability that later required reconstructive surgery.

Conclusion: Posterolateral elbow impingement from hypertrophic synovial plicae can cause significant pain and disability in throwing athletes and golfers. With careful diagnosis and exclusion of other elbow problems, treatment with arthroscopic debridement and focused rehabilitation is highly successful and allows these athletes to return to their previous level of play.

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