Report of Rare Elbow Problem in Golfers and Throwing Athletes

In this study treatment of elbow pain caused by a thickened synovium is reported. Twelve athletes (golfers, baseball players, or baseball pitchers) had arthroscopic surgery to remove the extra tissue. All patients were followed for at least two years.

Lateral elbow pain (along the outside of the elbow) isn't as common as medial elbow pain along the inside of the elbow. When it occurs, the patient must be evaluated for an inflamed or thickened synovial plica. Synovium is the thin layer of membrane that lines joints. The plica is an extra piece or fold of synovium where the separate parts of the synovium join together.

Repetitive elbow motion like throwing a ball or swinging a golf club seem to put competitive athletes at increased risk for this problem. Elbow pain and snapping, clicking, or catching are common symptoms when the plica gets caught in the elbow joint. This condition is called elbow impingement.

Arthroscopic surgery can be done to shave away the plica. The athletes in this study all had at least three months of nonoperative treatment first. This included antiinflammatory drugs, physical therapy, and change in activity level. More than half also had a steroid injection. There was only temporary relief from the painful symptoms.

After surgery eight of the 12 had complete pain relief. The rest had only mild discomfort or occasional pain during their sports activity. Clicking, snapping, or catching but without pain persisted for two patients. All but one patient went back to their previous level of competitive play.

The authors conclude careful diagnosis is needed to identify synovial plica as the cause of elbow impingement. Arthroscopic treatment can help return athletes to the playing field.

References: David H. Kim, MD, et al. Arthroscopic Treatment of Posterolateral Elbow Impingement from Lateral Synovial Plicae in Throwing Athletes and Golfers. In The American Journal of Sports Medicine. March 2006. Vol. 34. No. 3. Pp. 438-444.