Elbow Synovial Fold Syndrome
MR Imaging Findings
Hitomi Awaya1,2,
Mark E. Schweitzer1,
Sunah A. Feng3,
Tamotsu Kamishima1,
Phillip J. Marone4,
Shella Farooki3,
Debra J. Trudell3,
Parviz Haghighi5 and
Donald L. Resnick3
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.
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Fig. 1. —Drawing shows anterior and posterior synovial folds.
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Fig. 2A. —Cadaver of 57-year-old man who had no history of locking
syndrome. Axial T1-weighted spin-echo fat-suppressed MR arthrogram (500/22,
TR/TE) shows curved synovial fold (black arrow) in posterolateral
olecranon recess. Note small triangular enfolding (white arrow) of
synovium in posterolateral olecranon. Such enfolding is considered a normal
variant.
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Fig. 2B. —Cadaver of 57-year-old man who had no history of locking
syndrome. Axial cadaveric section shows typical location of synovial fold
(arrows).
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Fig. 2C. —Cadaver of 57-year-old man who had no history of locking
syndrome. Photomicrograph of histologic specimen shows overall appearance of
plica with synovial type configuration and polypoid projection of
synovial-lined structure (arrows). (H and E,x16)
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Fig. 2D. —Cadaver of 57-year-old man who had no history of locking
syndrome. Photomicrograph of histologic specimen of plica shows cuboidal
synoviocytes (arrowheads) covering plica (arrow). (H and
E,x100)
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Fig. 3. —15-year-old boy with pain. Sagittal three-dimensional spoiled
gradient-recalled acquisition in steady state fat-suppressed MR image (TR/TE,
43.7/13.3; flip angle, 45°) shows 2-mm posterior synovial fold
(arrow) at tip of olecranon in superoposterior olecranon recess.
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Fig. 4. —25-year-old woman with chronic pain. Sagittal T1-weighted
spin-echo fat-suppressed direct MR arthrogram (TR/TE, 500/11) shows posterior
synovial fold (arrow) as wedge shape above tip of olecranon in
superoposterior olecranon recess.
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Fig. 5. —28-year-old man with locking elbow and pain. Sagittal
T1-weighted spin-echo fat-suppressed MR arthrogram (TR/TE, 403.3/9) shows
thick posterior synovial fold (arrows). This synovial fold was
confirmed at surgery and extended from triceps to posterior humeral surface in
superoposterior olecranon recess.
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Fig. 6. —38-year-old man with chronic pain. Sagittal three-dimensional
spoiled gradient-recalled acquisition in steady state fat-suppressed MR
arthrogram (TR/TE, 43.7/13.3; flip angle, 45°) shows prominent large
posterior synovial fold (arrow) at tip of olecranon in
superoposterior olecranon recess. Fold was confirmed at surgery.
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Fig. 7. —24-year-old man with chronic pain. Sagittal T1-weighted
spin-echo fat-suppressed direct MR arthrogram (500/11, TR/TE) shows focal fat
pad (arrow) projecting into superoposterior aspect of olecranon
recess.
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Copyright © 2001 by the American Roentgen Ray Society.
