Arthroscopic, Macroscopic, and Microscopic Anatomy of the Synovial Fold of the Elbow Joint in Correlation With the Common Extensor Origin

Tsuji, Hideki; Wada, Takuro; Oda, Takashi; Iba, Kosuke; Aoki, Mitsuhiro; Murakami, Gen; Yamashita, Toshihiko

doi:10.1016/j.arthro.2007.07.020

Cited by 35 publications

(38 citation statements)

References 13 publications

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“…The synovial fold is a distinct entity from the annular ligament and is contiguous with the joint capsule, which fuses with the common extensor tendon forming an enthesis at the lateral epicondyle. This explains the deteriorating effect caused by lateral epicondylitis of the common extensor tendon which may consequently involve the synovial fold and hence induce hypertrophic changes 14) . Similarly, Ando et al confirmed a histological congruity between synovial fold and the articular capsule, sug- 12) .…”

Section: Discussionmentioning

confidence: 99%

“…We attribute this discrepancy to the lack of a clear and easy method where the junction between the synovial fold and articular capsule could be precisely identified on MR imaging. However, anatomic 8)12) and arthroscopic 14) assessments showed continuity between the synovial fold and the articular capsule on the proximal edge of the annular ligament, which may not always be readily and accurately identifiable on MR imaging. To this end, during our measurement process, and for the purpose of practicality, we replaced the articular capsule by the articular surface of the radial head at the proximal radioulnar joint as the outer edge of the synovial fold.…”

Section: Discussionmentioning

confidence: 99%

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The Radiohumeral Synovial Fold: Analysis with 3D Isotropic MR Imaging in 80 Asymptomatic Subjects

Kitsukawa

Tachizawa

Kobayashi

et al. 2015

J St. Marianna Univ

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Purpose: To evaluate prospectively the size of the synovial fold protruding into the radiohumeral joint using 3D isovoxel MR imaging in asymptomatic volunteers, and to find a new reference value of the synovial fold on MR imaging. Materials and methods: Eighty asymptomatic volunteers (36 women, 44 men; age range, 23-56 years; median age, 39; 20 patients in each decade from 20s to the 50s) were examined in this study. MR imaging of both sides of the elbow was performed using 3D isovoxel fast field-echo sequence with selective water excitation. The width of the synovial fold, which is defined as the distance between the tip of the synovial fold and the outer edge of the radial head, was measured at eight locations on the radiohumeral joint. We analyzed the relationship between the results and age, sex, and handedness. Results: The posterior synovial fold was largest (range, 0.2-11.6 mm; median, 6.9 mm; 95th percentile, 10.0 mm). The width of the lateral synovial fold and posterolateral synovial fold was larger in patients in their 50s than in their 20s (p < 0.05 and p < 0.01, respectively). Conclusion: Most normal synovial folds are smaller than 10.0 mm in width. Aging is a factor which influences the width of lateral to posterolateral synovial folds.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Radiohumeral Synovial Fold: Analysis with 3D Isotropic MR Imaging in 80 Asymptomatic Subjects

Kitsukawa

Tachizawa

Kobayashi

et al. 2015

J St. Marianna Univ

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“…Mullet et al [23] reported 93% complete relief of symptoms using only arthroscopic synovial excision, thus suggesting that the main pathologic features might not be the ECRB or there might be a common healing process that could be activated by a posterior synovial fold excision. Tsuji et al [30], in their study of the histologic features of the common extensor tendon, suggested the joint capsule and posterior synovial fold might be involved in the pathogenesis of lateral epicondylitis owing to its location near the origin of the ECRB. It sometimes might be necessary to simultaneously treat the posterior synovial fold and joint capsule to achieve symptom improvement in lateral epicondylitis.…”

Section: Discussionmentioning

confidence: 99%

“…Tsuji et al [30] Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.…”

Section: Introductionmentioning

confidence: 99%

Is Posterior Synovial Plica Excision Necessary for Refractory Lateral Epicondylitis of the Elbow?

Rhyou

Kim

2013

Clinical Orthopaedics &Amp; Related Research

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Background Arthroscopic treatments for lateral epicondylitis including débridement of the extensor carpi radialis brevis (ECRB) origin (Baker technique) or resection of the radiocapitellar synovial plica reportedly improve symptoms. However the etiology of the disease and the role of the plica remain unclear. Results Two years postoperatively, we found no differences in the VAS pain score or DASH: the mean VAS pain scores were 0.3 points in Group A and 0.4 points in Group B, and the DASH scores were 5.1 points and 6.1 points respectively. Conclusions The addition of débridement of the posterior synovial fold did not appear to enhance either pain relief or function compared with the classic Baker technique without decortication. Level of Evidence Level III, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.

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“…The CEO, a fibrocartilaginous enthesis, was chosen because it is regularly used for studies of activity-related stress and the soft tissues attaching at this site have been well studied (Greenbaum et al, 1999;Putz et al, 2003;Milz et al, 2004;Tsuji et al, 2008). Anatomical differences between fibrous and fibrocartilaginous entheses have only recently been acknowledged by those studying activity-related stress (Henderson, 2008;Alves Cardoso and Henderson, 2010;Villotte et al, 2010) but should be recognized when developing recording methods (Jurmain et al, 2012).…”

Section: Methodsmentioning

confidence: 99%

Technical note: Quantifying size and shape of entheses

Henderson

2013

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Entheseal changes (ECs) have been widely recorded using visual methods, but size and shape affect stress distribution which cannot be quantified visually. The aim of this paper is to present a simple method for quantifying size and shape by applying parameters to quantify shape and to highlight preliminary results indicating that this method provides useful data. Hypotheses tested were: common extensor origin size correlates with humerus size; ECs change the size and shape of entheses; surface area is increased in those entheses with bony proliferation. The common extensor origins of 43 male skeletons from medieval York were recorded. The entheses were recorded visually for any deviation from a smooth surface. The chord was measured using sliding calipers and the shape of the entheses recorded using a profile gauge and quantified using parameters (e.g. the standard deviation of the surface from a mean line) which assess the relationship of the surface to a flat surface. To test replicability, disarticulated humeri were also recorded (inter-observer error n = 9; intra-observer error n = 20) using the same methodology. Replicability for size and shape was good for intra-observer error but weaker for inter-observer error. There is variability in enthesis size and distal humeral condyle size; normal entheses are smaller than those with EC while their surface shape differs and is affected by the type of EC (proliferative or destructive); surface area in those entheses with proliferative ECs is increased. The use of these parameters for quantifying enthesis size and shape provides insights into enthesis variability which cannot be tested using visual methods alone. These parameters can be recorded using this two-dimensional method or can be measured on data collected with a laser scanner. Future research will test the relationship between surface size/shape and the effects of biological sex, age and occupation.

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Arthroscopic, Macroscopic, and Microscopic Anatomy of the Synovial Fold of the Elbow Joint in Correlation With the Common Extensor Origin

Cited by 35 publications

References 13 publications

The Radiohumeral Synovial Fold: Analysis with 3D Isotropic MR Imaging in 80 Asymptomatic Subjects

The Radiohumeral Synovial Fold: Analysis with 3D Isotropic MR Imaging in 80 Asymptomatic Subjects

Is Posterior Synovial Plica Excision Necessary for Refractory Lateral Epicondylitis of the Elbow?

Technical note: Quantifying size and shape of entheses

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