Basic Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2018; 9(4): 65-71
Published online Apr 18, 2018. doi: 10.5312/wjo.v9.i4.65
Snapping elbow-A guide to diagnosis and treatment
Jonathan Jetsmark Bjerre, Finn Elkjær Johannsen, Martin Rathcke, Michael Rindom Krogsgaard
Jonathan Jetsmark Bjerre, Martin Rathcke, Michael Rindom Krogsgaard, Section for Sportstraumatology M51, Bispebjerg-Frederiksberg Hospital, Copenhagen NV DK-2400, Denmark
Finn Elkjær Johannsen, Institute for Sportsmedicine M81, Bispebjerg-Frederiksberg Hospital, Copenhagen NV DK-2400, Denmark
Author contributions: Rathcke M and Krogsgaard MR designed the study; Johannsen FE and Rathcke M recorded the case stories; Bjerre JJ did the literature analyses; Bjerre JJ and Krogsgaard MR wrote the paper.
Institutional review board statement: The project was considered a register research project by Danish Committee System on Health Research Ethics.
Conflict-of-interest statement: None of the authors have any proprietary interests in the materials described in the article.
Data sharing statement: Not applicable.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Michael Rindom Krogsgaard, MD, PhD, Professor, Surgeon, Section for Sportstraumatology M51, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, Copenhagen NV DK-2400, Denmark.
Telephone: +45-31226817
Received: November 11, 2017
Peer-review started: November 11, 2017
First decision: December 11, 2017
Revised: December 21, 2017
Accepted: March 1, 2018
Article in press: March 2, 2018
Published online: April 18, 2018
Research background

Patients with snapping elbow (SE) are seen by orthopaedic surgeons, rheumatologists and physical therapists, but the diagnosis is rare.

Research motivation

Most health care workers have no clinical experience with SE, as it is a rare condition. Therefore, there is a risk of misdiagnosis and delay of relevant treatment. Snapping can be visible, audible and palpable, but usual diagnostic measures can fail to demonstrate pathology.

Research objectives

From a literature search combined with our own clinical experience we wanted to analyse what is known about SE, its diagnosis and its treatment. The main purpose was to present a guideline to identify the patho-anatomical cause of SE, its general binary categorization and the best treatment of each pathology.

Research methods

Literature was searched in PubMed and Scopus and key points in diagnosis and treatment were identified. Two typical cases are described.

Research results

Our review indicates that SE should be clinically divided into lateral and medial, and that diagnosis and treatment is a logic consequence of this. Lateral, intra-articular pathology is best diagnosed with high-resolution MRI, MR-arthrography or radiographic arthrography. Surgical intervention is the treatment of choice and successful in the majority of the cases. Medial, extra-articular pathology is best diagnosed by dynamic ultrasonography and during surgery. It is most commonly caused by subluxation of a medial part of the triceps tendon or the ulnar nerve. Treatment is by open surgery, except in patients with repeated, loaded activities during flexion and extension (at work or during sports), in which case symptoms may resolve by reduction of this activity.

Research conclusions

This guideline suggests a standardized approach to diagnosis and treatment of patients with SE. As early surgical intervention is recommended because the snapping can damage nerve (medial) or cartilage (lateral), this guideline is a tool for better patient care.

Research perspectives

There are no randomized studies on treatment of SE, but the largest series of 64 cases is on lateral SE, meaning that randomized controlled studies could be performed regarding treatment of this pathology. The other pathologies are too rare. There are probably many undiagnosed cases, and studies on incidence would describe the magnitude of this health problem.