Published online Apr 18, 2018. doi: 10.5312/wjo.v9.i4.65
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
Patients with snapping elbow (SE) are seen by orthopaedic surgeons, rheumatologists and physical therapists, but the diagnosis is rare.
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.
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.
Literature was searched in PubMed and Scopus and key points in diagnosis and treatment were identified. Two typical cases are described.
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.
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.
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.