Elbow plica syndrome in Vienna
Something snaps on the outside of the elbow, every straightening of the arm pulls, and treatment for tennis elbow has brought little. Sometimes the cause is a thickened fold of the joint lining: the snapping fold, medically called plica syndrome. I examine it on ultrasound during movement and discuss with you what helps in your case.
In short
A plica is a fold of the joint lining, left over from the development of the joint. At the elbow the important one lies outside, between radial head and humerus. Irritation from overload or a knock makes it thicken, and it then catches on straightening and bending — hence the snapping and the pain outside. Because the pain sits in almost the same place, the snapping fold is often taken for a tennis elbow. I secure the diagnosis on ultrasound during movement; treatment is conservative first, and if the catching stays, I remove the fold arthroscopically.
What is a snapping fold of the joint lining (plica syndrome)?
The elbow joint is lined inside by the joint lining (synovium). Before birth, thin walls still divide the joint into chambers. These walls recede, but remnants remain as folds. Such a fold is called a plica — not a disease, but a normal form.
As long as it stays thin and soft, the plica gives way with every movement and stays silent. The one that matters most clinically lies on the outside, at the junction between the radial head and the humerus. There the gap is narrowest, and there the radius turns with every rotation of the hand.
Through repeated leaning, turning and gripping, through racquet sports or after a fall onto the elbow, the fold becomes inflamed. It turns tough and loses its give. From then on every straightening and bending pushes it over the edge of the radial head, and it springs back — that is the snapping. If the irritation persists, it rubs against the cartilage of the radial head.
Typical symptoms
- Snapping outside the elbow — audible or felt as a jump, on straightening and bending
- Pain over the outer joint line — slightly further back than in tennis elbow
- A sense of catching — the arm catches briefly and then moves on
- Pain on turning the forearm — door handle, screwdriver, opening a bottle
- Little effect from tennis elbow treatment — despite rest, brace and physiotherapy
How I make the diagnosis
First I ask about the course of the symptoms and the movement that brings them on. In the examination I feel along the outer joint line while I straighten the arm, bend it and turn the forearm. If the snapping comes on that way and the tenderness lies behind the tendon attachment, that speaks for a plica. Then I examine with ultrasound during movement: on the moving image the thickened fold jumps over the edge of the radial head, along with effusion and capsule thickness. A still image does not show that. To rule out other causes I arrange an X-ray, and an MRI if cartilage damage is suspected.
Mistaken for tennis elbow
Both cause pain outside the elbow, under the same loads. In tennis elbow (epicondylitis lateralis) the tenderness sits on the bony prominence of the outer tendon attachment, and straightening the wrist against resistance hurts. In plica syndrome the pain lies further back over the joint line, it snaps, and the resistance test often stays unremarkable.
The two can exist side by side. Treatment of tennis elbow then improves the symptoms only in part — a common reason why it does not respond as expected. Loose bodies and elbow instability are further possible causes; the page on elbow pain gives an overview.
Treatment: conservative first
The aim is to calm the inflammation and give the fold room again. Loading comes first: leaning on the arm, repeated turning and hard impacts are left out for a while. Physiotherapy and exercise therapy — both in the same building at the Orthozentrum Döbling — work on mobility, muscular control and technique at work and in sport.
If the irritation persists, I treat further in the practice: an ultrasound-guided injection brings the medication precisely to the irritated fold, and magnetic field therapy supports this. If the tendon attachment is irritated too, shockwave therapy and PRP therapy are added. What these routes cannot do I say openly: a toughly scarred fold does not resolve through exercises.
When an operation is necessary
If the catching persists and symptoms, examination and ultrasound fit together, I remove the fold in an elbow arthroscopy. Through small access points a camera and fine instruments reach the joint; the plica is exposed under direct view and removed. In the same procedure I assess the cartilage of the radial head and remove any loose bodies.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare. Afterwards early movement is what counts, because the elbow tends to stiffen; if the arm stays restricted, arthrolysis for the stiff elbow helps.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. More details are on the page about how a private practice works; an overview can be found under elbow surgery in Vienna.
Whether the fold is removed is not decided by the ultrasound image alone. I make that choice together with you once the findings are in.
Frequently asked
Common questions about plica syndrome
A plica is a fold of the joint lining, left over from the development of the joint before birth. As long as it stays thin and soft, it gives way with every movement. Only when it turns inflamed, thickened and tough does it catch.
By the snapping. On straightening and bending, something jumps over the edge outside the elbow, audible or clearly felt. Pain over the outer joint line comes with it, stronger on turning the forearm and on leaning. Sometimes the arm catches briefly and then moves on.
By the site of the pain and by the snapping. In tennis elbow the tenderness sits on the bony prominence of the outer tendon attachment, and straightening the wrist against resistance hurts. In plica syndrome the pain lies further back over the joint line, and the fold snaps.
Through the clinical examination and ultrasound during movement. I feel along the outer joint line while I straighten the arm, bend it and turn the forearm, and try to bring on the snapping. On the moving image the thickened fold jumps over the edge of the radial head. I arrange an X-ray or MRI to rule out other causes.
Often yes, above all in a fresh state of irritation. Adjusted loading, physiotherapy, an ultrasound-guided injection and magnetic field therapy calm the irritated fold. If the tendon attachment is irritated too, shockwave therapy and PRP therapy are added. A toughly scarred fold does not, however, resolve through exercises.
Some folds settle once the loading that brought them on falls away. If the irritation persists, the thickened fold rubs against the cartilage of the radial head with every movement and can damage it. That is why I assess persistent snapping with pain rather than sitting it out.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.