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<v ->One of the characteristic places that we see plica,

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the elbow joint.

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And although they are described

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and shown here by diagram to occur

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in all quadrants of the elbow joint,

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most of the attention has been directed

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as those synovial folds or plica

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that are located laterally or postal laterally.

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And in fact, you'll come across a name

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the synovial fringe syndrome,

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when the folds in this area, or plica,

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become too thick and lead to symptoms.

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So I think this is a fairly well established entity.

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Now, we've done some anatomic work trying to look

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at this particular lateral synovial fringe.

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And here are some pictures taken

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from one of the articles that we did on this.

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And this is a short lateral synovial fringe,

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or plica here.

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You see it doesn't extend very far immediately.

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It doesn't cover any of the radial head.

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And when you look at its anatomy,

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you can see it's kind an extension of the annular ligament,

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the posterior aspect shown here,

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and is very intimate with the radial collateral ligament.

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So that's what it looks like in most persons.

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Very, very small.

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It has a function.

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It said in fact, to serve as a cushion.

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Particularly, when the radial aspect

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of the elbow is compressed.

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It will act as a cushion between the radial head

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and the capitella or capitulum of the humerus.

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On the top, again, that image showing you

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what a normal one looks like.

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And then, I'm showing you some examples

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where it looked pretty thick.

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Now, whether or not it's too thick,

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I don't know.

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There are criteria that suggests

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when this might be symptomatic.

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If in fact the thickness top the bottom is greater

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than three millimeters, or if it extends

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and covers more than one third of the radial head,

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it is said to be more likely symptomatic.

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This is what it might look like at.

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And when you see this,

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you see it laterally or posteriorly or poster laterally.

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So this is kind of what it looks like.

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Now to show you some examples, a beautiful article

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in the literature showing you picture-wise,

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and also in specimens, and with MRI, and photographs

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what a thicken lateral synovial fringe looks like.

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So here is what it looks like diagrammatically.

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We see changes involving the area, the capitella.

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More about that in a moment.

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And the area of the radial head.

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This is what it would look like diagrammatically

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in the transverse plane.

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Here's the abnormal tissue,

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extending along that lateral and postal lateral aspect.

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And here you can see it.

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I think this was an ortho gram,

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but showing you the abnormal tissue.

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So that's what it looks like.

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Now, one of the interesting things,

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if you look at the site of erosion

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that occurs in the capitella or capitulum,

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whichever term you prefer,

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it tends to occur in an area that is known as

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the pseudodefect of the capitulum.

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There's an area normally that's irregular,

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right at the periphery of the articular cartilage

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before you move into the area of the lateral condyle

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or an epicondyle.

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And that normally can be irregular,

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but one of the areas of pathology that you see

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when you have this lateral synovial fringe

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is right in that same area.

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So that normal pseudodefect may enlarge

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and may become symptomatic.

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So it's almost like a pseudo,

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pseudodefect of the capitulum.

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You go into the literature,

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and I'm aware of this literature,

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because in fact,

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some of it was produced by one of our previous

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visiting scholars from Taiwan, Gushu Huang as shown here.

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He has other names for some of the tissue that occurs here.

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This was pathologically called a "meniscus", not a plica,

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not a synovial fringe when it was removed,

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it was producing clicking

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in the lateral aspect of the elbow.

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And he shared with me this case many years ago,

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which is an interesting case showing abnormal tissue

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right in the area where we expect to see that

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synovial fringe associated with cartilage damage

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and even bone abnormalities.

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And this is the location that you will see

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with a partially torn and annular ligament.

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Where the upper half of the torn ligament

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will sublux into the joint.

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And this is a proven case where that filling defect

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in the joint effusion was indeed not a plica,

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but was portion of the annular ligament.

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There are plica described elsewhere in the elbow joint.

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Here's an example of one.

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I don't know if it was symptomatic.

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You can see there was a pain marker.

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This was not operated on, but this is a posteromedial plica.

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Here's another one, posteromedial, low signal.

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Again, I don't have operative proof on these cases.

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So I don't know if they were important.

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And a posterolateral plica,

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this one taken from a literature

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where there was operative proof

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that this was a symptomatic condition.

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There are a lot of examples

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in the literature of posterior plica,

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and these have been seen at least in the United States.

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Particularly, in baseball pitchers,

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where you'll see strands of abnormal tissue.

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These are three different cases showing you

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what they look like.

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And in two of them are trust to be confirmed,

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that this was thickened fibers tissue called a plica.

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Something I learned about rather recently,

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upon reading this article,

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which is referenced at the bottom right,

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is that there are some additional areas

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of ligaments about the elbow.

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We all learn about the medial and lateral ligaments

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of the elbow.

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I'm not gonna be talking about those today,

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but there are additional areas

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in the capsule that are thicker.

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And these are seen both anteriorly and posteriorly.

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And I remember reading this article

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by eight or nine years ago,

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and I decided I wasn't really gonna learn the names

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of these various capsular regions or folds,

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but I did recognize they occurred anteriorly

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and posteriorly.

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I kind of forgot about this article, until recently,

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we came across a case that looked exactly

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like the case they reported.

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So here's an example

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from their report of thickened capsular folds posteriorly.

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I tried to figure out what they would be.

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They're probably that represent

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the posterior transverse folds.

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Here, they appeared thickened

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in this particular case from their article,

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they were read as thickened capsular folds.

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And then, not too long ago,

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we came across our own article or our own case,

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I should say, of thickened posterior capsular folds.

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And this was an interesting case.

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It looked like a ligament that I never had heard

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running all the way across the joint,

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but it is probably one

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of those posterior transverse capsular folds.

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And in this particular case,

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you'll know just deep to it as an interarticular body.

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Okay, so that was a body.

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You can kind of see it here.

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Perhaps trapped in that location by these folds.