Snapping Elbow Syndrome: Difference between revisions

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<div class="editorbox"> '''Original Editor '''- [[User:Jonathan Wong|Jonathan Wong]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
<div class="editorbox"> '''Original Editor '''- [[User:Jonathan Wong|Jonathan Wong]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Introduction ==
Snapping elbow syndrome, also known as snapping [[Triceps brachii|tricep]] syndrome, is a rare condition characterised by a snapping sensation, and symptoms related to irritation or subluxation of the [[Ulnar Nerve|ulnar nerve]] at the cubital tunnel, or pain and inflammation from a dislocating triceps segment<ref>Rioux-Forker D, Bridgeman J, Brogan DM. Snapping Triceps Syndrome. The Journal of hand surgery [https://www.jhandsurg.org/article/S0363-5023(17)30390-8/fulltext (American ed). 2018;43(1):90.e1–90.e5.]
 </ref><ref name=":0">Spinner RJ, Goldner RD. Snapping of the medial head of the triceps: diagnosis and treatment. Techniques in Hand & Upper Extremity Surgery. [https://pubmed.ncbi.nlm.nih.gov/16520623/ 2002 Jun 1;6(2):91-7.]</ref>. It is a dynamic condition occurring during either elbow flexion or extension with a snap on both active and passive movement<ref name=":0" />. Dislocation of the triceps tendon may happen over either the medial or the lateral epicondyle, however it occurs far more commonly over the medial one<ref>Spinner RJ, Goldner RD, Fada RA, Sotereanos DG. Snapping of the triceps tendon over the lateral epicondyle. The Journal of hand surgery. 1999 Mar [[Spinner RJ, Goldner RD, Fada RA, Sotereanos DG. Snapping of the triceps tendon over the lateral epicondyle. The Journal of hand surgery. 1999 Mar 1;24(2):381-5.|1;24(2):381-5.]]</ref>.
Snapping elbow syndrome occurs at a mean age of 32 years (''n'' = 30), ranging from 14-65 years with a male to female ratio of 6.5:1<ref>Shuttlewood K, Beazley J, Smith CD. Distal triceps injuries (including snapping triceps): A systematic review of the literature. World J Orthop. 2017 Jun 18;8(6):507-513. doi: 10.5312/wjo.v8.i6.507. PMID: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478494/ 28660143; PMCID: PMC5478494.]</ref>.
== Clinical presentation ==
* Snapping is audible, palpable, and usually visible<ref name=":1">Bjerre JJ, Johannsen FE, Rathcke M, Krogsgaard MR. Snapping elbow-A guide to diagnosis and treatment. World J Orthop. 2018 Apr 18;9(4):65-71. doi: 10.5312/wjo.v9.i4.65. PMID: 29686971; PMCID: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5908985/ PMC5908985.]</ref>. 
* Can have elbow pain or ulna neuropathy if dislocating medially<ref name=":0" />
* Can be asymptomatic<ref>Spinner RJ, An KN, Kim KJ, Goldner RD, O'Driscoll SW. Medial or lateral dislocation (snapping) of a portion of the distal triceps: a biomechanical, anatomic explanation. Journal of shoulder and elbow surgery. [[Spinner RJ, An KN, Kim KJ, Goldner RD, O'Driscoll SW. Medial or lateral dislocation (snapping) of a portion of the distal triceps: a biomechanical, anatomic explanation. Journal of shoulder and elbow surgery. 2001 Nov 1;10(6):561-7.|2001 Nov 1;10(6):561-7.]]</ref>
* Snapping triceps can present bilaterally, but may not be symptomatic on both sides<ref>Spinner RJ, Goldner RD. Snapping of the medial head of the triceps and recurrent dislocation of the ulnar nerve. Anatomical and dynamic factors. JBJS. 1998 [https://journals.lww.com/jbjsjournal/fulltext/1998/02000/snapping_of_the_medial_head_of_the_triceps_and.11.aspx?casa_token=yAOJtEWsT3cAAAAA:VxKzxX0WrwChiX_IEzdc6NSrjKgMK_gBP14sSQ9K77TjCJhe_OQhuF_g26RqHYN4-_5PNUUdFGXOSzPPYMse8BgbCPq2 Feb 1;80(2):239-47.]</ref>
== Diagnostic tools ==
Ultrasound is the tool of choice due to its dynamic nature and ability to differentiate between a snapping triceps tendon or ulna nerve<ref>Chuang HJ, Hsiao MY, Wu CH, Özçakar L. Dynamic ultrasound imaging for ulnar nerve subluxation and snapping triceps syndrome. American Journal of Physical Medicine & Rehabilitation. 2016 Jul [https://journals.lww.com/ajpmr/Fulltext/2016/07000/Dynamic_Ultrasound_Imaging_for_Ulnar_Nerve.12.aspx?casa_token=7vPDFSymAnsAAAAA:iM0Dx9C1towjjcsfb3Wx8EKUw58ft5iS-QSEcmn8ID_MQoaICCXnwratL7l7UpILp8sYgy9mlmv43CWyycmbVSzzmqyA 1;95(7):e113-4.]</ref>.
Spinner (2002) postulated that a snapping ulna nerve and snapping triceps could be differentiated by the angle at which the snapping occurred - the ulna nerve is thought to snap at '''70-90 degrees of flexion''', whereas the triceps is thought to snap at around '''115 degrees of flexion'''<ref name=":0" />'''.'''
== Treatment ==
It is useful to distinguish between lateral and medial tricep dislocation, as pathology, diagnostic strategy and treatment are different in the two situations<ref name=":1" />.

Revision as of 12:54, 4 November 2023

Original Editor - Jonathan Wong Top Contributors - Jonathan Wong and Kim Jackson

Introduction[edit | edit source]

Snapping elbow syndrome, also known as snapping tricep syndrome, is a rare condition characterised by a snapping sensation, and symptoms related to irritation or subluxation of the ulnar nerve at the cubital tunnel, or pain and inflammation from a dislocating triceps segment[1][2]. It is a dynamic condition occurring during either elbow flexion or extension with a snap on both active and passive movement[2]. Dislocation of the triceps tendon may happen over either the medial or the lateral epicondyle, however it occurs far more commonly over the medial one[3].

Snapping elbow syndrome occurs at a mean age of 32 years (n = 30), ranging from 14-65 years with a male to female ratio of 6.5:1[4].

Clinical presentation[edit | edit source]

  • Snapping is audible, palpable, and usually visible[5].
  • Can have elbow pain or ulna neuropathy if dislocating medially[2]
  • Can be asymptomatic[6]
  • Snapping triceps can present bilaterally, but may not be symptomatic on both sides[7]

Diagnostic tools[edit | edit source]

Ultrasound is the tool of choice due to its dynamic nature and ability to differentiate between a snapping triceps tendon or ulna nerve[8].

Spinner (2002) postulated that a snapping ulna nerve and snapping triceps could be differentiated by the angle at which the snapping occurred - the ulna nerve is thought to snap at 70-90 degrees of flexion, whereas the triceps is thought to snap at around 115 degrees of flexion[2].

Treatment[edit | edit source]

It is useful to distinguish between lateral and medial tricep dislocation, as pathology, diagnostic strategy and treatment are different in the two situations[5].

  1. ↑ Rioux-Forker D, Bridgeman J, Brogan DM. Snapping Triceps Syndrome. The Journal of hand surgery (American ed). 2018;43(1):90.e1–90.e5.  
  2. ↑ 2.0 2.1 2.2 2.3 Spinner RJ, Goldner RD. Snapping of the medial head of the triceps: diagnosis and treatment. Techniques in Hand & Upper Extremity Surgery. 2002 Jun 1;6(2):91-7.
  3. ↑ Spinner RJ, Goldner RD, Fada RA, Sotereanos DG. Snapping of the triceps tendon over the lateral epicondyle. The Journal of hand surgery. 1999 Mar 1;24(2):381-5.
  4. ↑ Shuttlewood K, Beazley J, Smith CD. Distal triceps injuries (including snapping triceps): A systematic review of the literature. World J Orthop. 2017 Jun 18;8(6):507-513. doi: 10.5312/wjo.v8.i6.507. PMID: 28660143; PMCID: PMC5478494.
  5. ↑ 5.0 5.1 Bjerre JJ, Johannsen FE, Rathcke M, Krogsgaard MR. Snapping elbow-A guide to diagnosis and treatment. World J Orthop. 2018 Apr 18;9(4):65-71. doi: 10.5312/wjo.v9.i4.65. PMID: 29686971; PMCID: PMC5908985.
  6. ↑ Spinner RJ, An KN, Kim KJ, Goldner RD, O'Driscoll SW. Medial or lateral dislocation (snapping) of a portion of the distal triceps: a biomechanical, anatomic explanation. Journal of shoulder and elbow surgery. 2001 Nov 1;10(6):561-7.
  7. ↑ Spinner RJ, Goldner RD. Snapping of the medial head of the triceps and recurrent dislocation of the ulnar nerve. Anatomical and dynamic factors. JBJS. 1998 Feb 1;80(2):239-47.
  8. ↑ Chuang HJ, Hsiao MY, Wu CH, Özçakar L. Dynamic ultrasound imaging for ulnar nerve subluxation and snapping triceps syndrome. American Journal of Physical Medicine & Rehabilitation. 2016 Jul 1;95(7):e113-4.
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