Snapping Elbow Syndrome: Difference between revisions

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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.]  
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>.
 </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>.
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>.
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* 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>.   
* 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" />
* Possible 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>
* 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>
* 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 ==
== 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>.
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>. Dynamic MRI can also be used to demonstrate dislocation<ref>Guillin R, Marchand AJ, Roux A, Niederberger E, Duvauferrier R. Imaging of snapping phenomena. The British journal of radiology. 2012 Oct;85(1018):1343-[https://www.birpublications.org/doi/full/10.1259/bjr/52009417?casa_token=XsYo7cmZzBYAAAAA%3Ajv1z5coTrU5eGLEBr5PPMp7NTNnXxpEjEu3h43AMe3eUodH40jQ9MKa2J3MA9dUK6qZqOfDrPoc 53.]</ref>, however on a standard MRI the elbow must be flexed for dislocation to be demonstrated<ref>Spinner RJ, Hayden Jr FR, Hipps CT, Goldner RD. Imaging the snapping triceps. AJR. American journal [https://www.ajronline.org/doi/abs/10.2214/ajr.167.6.8956595 of roentgenology. 1996 Dec;167(6):1550-1.]</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" />'''.'''
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" />'''.'''
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== Treatment ==
== 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" />.
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" />.
Initially, conservative measures can be attempted, such as avoidance of exacerbating factors (eg, weight lifting) and a course of NSAIDs for 3-6 months<ref name=":0" />. Some practitioners also recommend avoiding sustained or repetitive elbow flexion, and orthosis fabrication of the elbow at 70° of flexion<ref name=":0" />.
If unsuccessful, surgery will be considered. Surgery can include resection of the triceps edge, transposition of the tendon or the ulnar nerve and correction of cubitus varus<ref name=":0" /><ref>Spinner RJ, O'Driscoll SW, Davids JR, Goldner RD. Cubitus varus associated with dislocation of both the medial portion of the triceps and the ulnar nerve. The [https://www.sciencedirect.com/science/article/abs/pii/S0363502399028555 Journal of hand surgery. 1999 Jan 1;24(4):718-26.]</ref>.


== References ==
== References ==

Revision as of 06:05, 10 December 2023

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

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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].
  • Possible 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]. Dynamic MRI can also be used to demonstrate dislocation[9], however on a standard MRI the elbow must be flexed for dislocation to be demonstrated[10].

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].

Initially, conservative measures can be attempted, such as avoidance of exacerbating factors (eg, weight lifting) and a course of NSAIDs for 3-6 months[2]. Some practitioners also recommend avoiding sustained or repetitive elbow flexion, and orthosis fabrication of the elbow at 70° of flexion[2].

If unsuccessful, surgery will be considered. Surgery can include resection of the triceps edge, transposition of the tendon or the ulnar nerve and correction of cubitus varus[2][11].

References[edit | edit source]

  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 2.4 2.5 2.6 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 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
  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. 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.
  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.
  9. ↑ Guillin R, Marchand AJ, Roux A, Niederberger E, Duvauferrier R. Imaging of snapping phenomena. The British journal of radiology. 2012 Oct;85(1018):1343-53.
  10. ↑ Spinner RJ, Hayden Jr FR, Hipps CT, Goldner RD. Imaging the snapping triceps. AJR. American journal of roentgenology. 1996 Dec;167(6):1550-1.
  11. ↑ Spinner RJ, O'Driscoll SW, Davids JR, Goldner RD. Cubitus varus associated with dislocation of both the medial portion of the triceps and the ulnar nerve. The Journal of hand surgery. 1999 Jan 1;24(4):718-26.
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