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Elbow Synovial Fold Syndrome

MR Imaging Findings

¹ Department of Radiology, Thomas Jefferson University Hospital, 132 S. 10th St., 1096 Main Bldg., Philadelphia, PA 19107.
² Present address: Department of Radiology, Shimonoseki City Hospital, 1-13-1 Kohyohcho, Shimonoseki, Yamaguchi 750-8520, Japan.
³ Department of Radiology, Veterans Affairs Medical Center and University of California, 3350 La Jolla Village Dr., San Diego, CA 92161.
⁴ Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107.
⁵ Department of Pathology, Veterans Affairs Medical Center and University of California, San Diego, CA 92161.

OBJECTIVE. We describe the anatomy and MR imaging appearance of elbow plicae.

MATERIALS AND METHODS. First, five cadavers were evaluated by sectioning and using MR arthrography for evidence of normal or prominent synovial folds to determine the potential origin of elbow plicae. Next, 164 consecutive MR images were evaluated to determine the frequency of the plicae in a clinical population. Last, we retrospectively studied a selected group of eight patients who underwent preoperative MR imaging and in whom enlarged synovial folds were confirmed at surgery.

RESULTS. In the cadavers, the synovial fold appeared to originate from the synovium adjacent to a posterior fat pad. In the clinical population, half the patients showed a synovial fold at the same location; however, most folds were less than or equal to 2 mm in thickness. The eight patients presented clinically with symptoms mimicking an intraarticular body. The synovial fold in symptomatic patients was seen posteriorly just above the olecranon and averaged 3 mm in thickness.

CONCLUSION. A synovial fold extending from the posterior fat pad in the elbow is a frequent finding on MR imaging. In a subgroup of patients, plicae, when thickened, may present clinically as a locking elbow. However, overlap exists between the thicknesses of symptomatic and asymptomatic plicae.

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