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Now let's talk briefly about synovial folds.

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Intraarticular. Synovial folds are found in many different

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articulations, and in some regions we designate

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them pica.

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They have been identified in all quadrants

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of the elbow joint,

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but there's one of these that deserves special emphasis,

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and it is a lateral synovial fold.

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Some people call this a synovial fringe.

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I wanted to show you what a small one looks like here. Okay.

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You can see intimate with the radial head, intimate

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with the radial collateral ligament.

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These may enlarge and in some sense that's good

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because in fact, they served ex cushion

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protecting the radial head

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and Capella during axial compression,

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which you can see very, very nicely in this image compared

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to distraction.

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But they may also, when large create clinical findings

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and become symptomatic.

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I show you again at the top what is a very small

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or short, uh, pica or synovial fringe.

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And at the bottom something

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that is much more prominent and thick.

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If it is this thick,

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and particularly if it extends over a significant amount

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of the Radiohead, it may be, uh, clinically significant.

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Now, there are some criteria

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that have been suggested in the literature.

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If the thickness, the maximum thickness is greater than

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three millimeters, or if it covers more than a third

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of the radial head, it likely is a significant play cut.

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Just to give you an idea of what we're talking about,

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beautiful pictures from Rizzo

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and his colleagues show you what this abnormal

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or pathologic lateral synovial foal can look like.

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It's thick all around,

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but many times it becomes thickest posterior

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to the radial head.

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And what it can do is produce changes in cartilage

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as well as in cartilage, in bone in the region of

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what we designated that pseudo defect.

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Here's a beautiful example with Mr showing you

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that enlarged tissue

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and what it looked like at the time of arthroscopy.

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I think I'm gonna show you yes, another case.

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This is one of the cases we had recently

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showing you enlargement of this lateral synovial fringe,

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producing a synovial fringe syndrome, which may lead

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to loss of articular cartilage and two bone uh, changes.

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So we may end up with something like this looking like

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a pseudo defect,

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but it may relate to erosion created

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by an enlarged synovial fringe.

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So maybe it is a pseudo pseudo defect

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of the Capella.