Exploring the Branching Pattern of the Posterior Division of the Internal Iliac Artery: An Analysis Based on 75 Computed Tomography Angiographies.

INTRODUCTION AND HYPOTHESIS: The internal iliac artery stands as the main blood supplier of the pelvis, serving as the primary source of blood for the pelvic viscera while also nourishing the musculoskeletal framework within. The arterial anatomy of the pelvis exhibits a vast array of variations, especially regarding the branching pattern of the internal iliac arteries. The posterior division of the internal iliac artery (PDIIA) may also have variable topography, especially regarding the location of its origin in the pelvic region. METHODS: A retrospective study was carried out to determine the anatomical variations, prevalence, and morphometric data of the PDIIA and its branches. A total of 75 computed tomography angiographies were analyzed. RESULTS: The most prevalent branch of the PDIIA was the superior gluteal artery, as it was present in 114 of the studied cases (77.03%). The median diameter of the PDIIA at its origin was 6.66 mm. The median cross-sectional area of the PDIIA at its origin was set to be 34.59 mm2. CONCLUSION: Our study highlights the critical significance of understanding the PDIIA and its branches in surgical interventions aimed at managing pelvic hemorrhage. The present study provides valuable insights into the precise localization and characteristics of the PDIIA and its branches, which are essential for surgical procedures targeting specific vessels to control bleeding effectively. Owing to the high level of variability of the branching pattern of the PDIIA, a novel classification system consisting of six types was created.

Exploring the Topography of the Obturator Artery and Corona Mortis: a Detailed Analysis with Surgical Implications.

INTRODUCTION AND HYPOTHESIS: The obturator artery (ObA) is described as a branch of the anterior division of the internal iliac artery. It arises close to the origin of the umbilical artery, where it is crossed by the ureter. The main goal of the present study was to create an anatomical map of the ObA demonstrating the most frequent locations of the vessel's origin and course. METHODS: In May 2022, an evaluation of the findings from 75 consecutive patients who underwent computed tomography angiography studies of the abdomen and pelvis was performed. RESULTS: The presented results are based on a total of 138 arteries. Mostly, ObA originated from the anterior trunk of the internal iliac artery (79 out of 138; 57.2%). The median ObA diameter at its origin was found to be 3.34 mm (lower quartile [LQ] = 3.00; upper quartile [UQ] = 3.87). The median cross-sectional area of the ObA at its origin was found to be 6.31 mm2 (LQ = 5.43; UQ = 7.32). CONCLUSIONS: Our study developed a unique arterial anatomical map of the ObA, showcasing its origin and course. Moreover, we have provided more data for straightforward intraoperative identification of the corona mortis through simple anatomical landmarks, including the pubic symphysis. Interestingly, a statistically significant difference (p < 0.05) between the morphometric properties of the aberrant ObAs and the "normal" ObAs originating from the internal iliac artery was found. It is hoped that our study may aid in reducing the risk of serious hemorrhagic complications during various surgical procedures in the pelvic region.

Embryological basis of polyorchidism including classification, reproductive potential, and risk of malignancy: A review.

Polyorchidism, a congenital malformation characterized by supernumerary testes (SNTs), is usually revealed incidentally during ultrasound or open scrotal surgery. In the approximately 200 cases so far published in the literature, the left side is affected more often than the right. Despite the rarity of this anomaly, a surgeon must have basic knowledge of its embryological basis and classifications to implement proper treatment and avoid overlooking it, since the consequences could harm the patient. This review summarizes previous classifications. It can be assumed that determining the risk of malignancy, and the level of reproductive potential based on location, vascularization, ductus deferens drainage, and environmental factors (e.g., temperature) affecting the SNTs, indicates the best approach to management. Therefore, we have created a new classification based on previous ones, addressing the aforementioned issues, which will guide the clinician to select the most appropriate treatment.

An arterial map of the uterine artery - a tool for endovascular and gynecological procedures.

INTRODUCTION: The anatomy of the uterine artery (UA) is highly complex, demonstrating various patterns of origin and course. The main objective of the present study is to provide the first anatomical heat map of the UA, demonstrating the location of its origin and course in the pelvis. METHODS: In July 2022, an assessment was conducted on the findings from 40 consecutive female patients who had undergone computed tomography angiography of the abdomen and pelvis. Morphometric features of the UA and its associated anatomical area were gathered in 19 categories. RESULTS: The presented results are based on a total of 58 UAs. 40 UAs originated from the anterior trunk of the internal iliac artery (69.0%), 16 of the UAs originated from the umbilical artery (27.6%), and the remaining two originated from the inferior gluteal artery (3.4%). The median diameter of the UA at its origin was found to be 3.20 mm (LQ = 2.63; HQ = 3.89). CONCLUSION: The anatomy of the UA is highly complex, showcasing variable topography, origin patterns, and morphometric properties. In the present study, a novel arterial map of this vessel was made, highlighting the diversity in its origin location and course. In our studied cohort, the UA originated most commonly from the anterior trunk of the internal iliac artery (69.0%), as described in the major anatomical textbooks. Having adequate knowledge about the anatomy of this artery is of immense importance in various gynecological and endovascular procedures, such as hysterectomies and embolizations.

Scapular foramina - a systematic review with meta-analysis based on 3316 scapulae.

PURPOSE: In the present study, we want to systematize the previous studies on the scapular foramina (SF) and nutrient foramina (NF) with emphasis on the clinical relevance of this topic. Although seemingly not important, radiologists, clinicians and surgeons should be aware of the presence and characteristics of the SF and NF and look out for possible mistakes that may cause harm to the patients during either the diagnostic process or surgery. METHODS: A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Web of Science, Embase, Cochrane Library and Google Scholar. The whole process was divided into three stages. In the first stage, the following search terms were used: ((scapular foramina) or (scapular foramen) or (scapular nutrient foramina) or (scapular nutrient foramen) or (scapula foramen) or (scapula foramina) or (scapula nutrient foramina)). RESULTS: The results of the present meta-analysis were based on a total of 3316 studied scapulae. A pooled prevalence of scapulae in which at least one SF was found was set to be 11.29%. The most common localization of the SF was found to be the infraspinous fossa, in which the SF occurred with the prevalence of 52.31%. Subsequently, a pooled prevalence of scapulae in which at least one NF occurs was established at 74.23%. CONCLUSION: The presented data contribute to a comprehensive understanding of the prevalence, distribution, and characteristics of suprascapular and nutrient foramina in scapulae, considering different topographical areas, genders, and sides.

Exploring the clinical characteristics and prevalence of the annular pancreas: a meta-analysis.

BACKGROUND: The annular pancreas (AP) is a rare gastrointestinal congenital malformation, in which malrotation of the pancreatic ventral bud in the seventh week of embryonic development manifests in a partial or complete ring of tissue around the second part of the duodenum. METHODS: The main online medical databases such as PubMed, ScienceDirect, Wiley online library, Web of Science, and EBSCO discovery service were used to gather all relevant studies on the AP. RESULTS: A total of 12,729,118 patients were analyzed in relation to the prevalence of AP. The pooled prevalence of AP was 0.0045% (95% CI: 0.0021%-0.0077%). The most frequent comorbidity in adults and children was duodenal obstruction, with a pooled prevalence of 24.04% and 52.58%, respectively (95% CI: 6.86%-46.48% and 35.56%-69.31%, respectively). The most frequent operation in adult patients with AP was duodenojejunostomy, with pooled prevalence established at 3.62% (95% CI: 0.00%-10.74%). CONCLUSION: The diagnostic complexity of AP is accentuated by its nonspecific clinical symptoms, making accurate identification reliant on imaging studies. Therefore, having a thorough knowledge of the clinical characteristics of the AP and its associated anomalies becomes paramount when faced with this rare congenital condition.

Assessing complications and functional outcomes in proximal humerus fracture management: a retrospective comparison between conservative and intramedullary nailing treatments.

INTRODUCTION: Fractures of the proximal end of the humerus (FPH) are the second most common fractures in the upper limb after fractures of the distal radius and are two to three times as common in women than in men. Therefore, the main objective of the present study was to compare and analyze the complications and the functional outcomes in patients with displaced FPH receiving conservative and surgical treatments with intramedullary nailing. METHODS: A retrospective cross-sectional study was conducted to establish the differences in complications risks between surgical and non-surgical treatment of the FPH. For this purpose, the clinical and radiological results of 67 consecutive patients were analyzed. RESULTS: A total of 25 patients were included in the non-surgically treated group. A total of 42 patients were included in the surgically treated group. Complications occurred in a total of 4 (16.0%) patients after the non-surgical treatment. Those included frozen shoulder (n = 2), nonunion (n = 1), and avascular necrosis of the humeral head (n = 1). Complications occurred in a total of 18 (42.6%) patients after the surgical treatment. Non-surgically treated patients had statistically significantly (p < 0.05) lower scores in the Constant-Murley scale in all of the categories. CONCLUSION: The present study demonstrates an overall prevalence of complications to be 16% in patients treated conservatively and 42.6% in patients treated surgically. In the non-surgical cohort, the frozen shoulder was the most frequently observed complication (8%). Interestingly, non-anatomical repositioning was the most prevalent complication in surgically treated patients. Due to the complexity of the FPH, we believe that the surgeon needs to have comprehensive knowledge regarding the characteristics of this fracture, the available treatment options, and the possible complications that may occur. This can enhance patient safety and provide satisfactory clinical outcomes.

Biomechanical evaluation of the wrist after scaphotrapeziotrapezoid arthrodesis.

BACKGROUND: The main objective of the present study was to present the biomechanical properties of the wrist in patients who underwent scaphotrapeziotrapezoid arthrodesis when compared to a healthy control hand. METHODS: The study group consisted of 29 consecutive patients who underwent a scaphotrapeziotrapezoid wrist arthrodesis at least 1 year before the research onset. Both hands of all patients were examined in 4 main categories. RESULTS: Average score obtained in the VAS, before the surgery, without motion of the wrist was 5.21 (SD = 3.04), whereas with wrist motion, it was 8.10 (SD = 1.37). Nineteen (65.52%) patients exhibited weakened wrist muscle strength. After the surgery, only 5 (17.24%) patients declared pain in the wrist. Furthermore, the results obtained in the VAS statistically significant differed from the ones before (p < 0.05). Twenty-eight (96.55%) patients were able to resume their profession. Twenty-seven (93.10%) patients stated that they would opt for the operation again. The peak torque during the analysis of extension of the wrist in the isometric protocol was found to be 8.1 Nm (SD = 2.9), 7.9 Nm (SD = 2.3), and 7.9 Nm (SD = 2.5) in the operated hands and 10.9 Nm (SD = 3.2), 9.6 Nm (SD = 2.9), and 9.1 Nm (SD = 3.8) in non-operated hand for 30° extension, no-flexion, and 30° flexion positions, respectively (p < 0.05). CONCLUSION: The current study is the first to present the biomechanical parameters of flexor and extensor muscles of the wrist and fingers in patients after the said procedure. Biomechanical assessments with additional isometric, isotonic, and isokinetic tests provide an opportunity to objectify treatment outcomes and guide appropriate rehabilitation by monitoring its effects. LEVEL OF EVIDENCE: III.

Evaluating patient satisfaction with WALANT for hand surgery: a comprehensive questionnaire-based study.

INTRODUCTION: There has been an increase in the popularity of the wide-awake local anesthesia no-tourniquet (WALANT) procedure for various upper limb surgeries. The present study aims to conduct a comprehensive analysis of the satisfaction levels of 106 patients, considering factors such as age, gender, comorbidities, and the specific procedures they underwent. METHOD: The present study was a retrospective cohort study conducted to analyze the overall satisfaction of a cohort of 106 patients who underwent various surgical procedures of the hand between 2018 and 2023. The satisfaction was assessed with a questionnaire comprising 13 questions/statements adjusted to a standard Swiss grading system (from 1 = I strongly agree to 6 = I strongly disagree). RESULTS: Overall satisfaction with WALANT was high, with most patients expressing positive experiences. Patients with hypertension reported similar satisfaction levels compared to those without, while diabetic patients experienced significantly higher anxiety levels during the procedure (p > 0.05). CONCLUSION: WALANT exhibits versatility as an anesthesia choice, demonstrating efficacy in both routine and complex hand surgeries. Our survey-based study reveals a high satisfaction level across diverse procedures. When assessing the correlation between WALANT satisfaction and patient comorbidities, hypertension displayed no significant impact, while diabetic patients reported heightened anxiety. Importantly, patient satisfaction remained consistently high even within the subgroup with comorbidities. Our results underscore WALANT's reliability in upper limb surgery, showcasing its usefulness and positive outcomes across a broad range of patients and surgical procedures.

Safety monitoring of drug-induced muscle injury and rhabdomyolysis: a biomarker-guided approach for clinical practice and drug trials.

Skeletal muscle tissue (SKM) may be damaged due to mechanical, metabolic, and exertional causes. However, drug-induced myopathy is among the most frequent causes of muscle disease. The clinical picture of drug-induced myopathies may be highly variable. It may present as asymptomatic or mild myalgias, with or without muscle weakness, which are likely underreported. However, it may also appear as chronic myopathy with severe weakness and, rarely, even as massive rhabdomyolysis with acute kidney injury (AKI). Unfortunately, the available biomarkers for SKM injury do not fully meet the needs for satisfactory detection of drug-induced damage, both in clinical and research settings, mainly due to their low sensitivity and specificity. Therefore, the present study proposes a strategy for drug safety monitoring using the available biomarkers of SKM injury. Moreover, we will discuss mechanisms of drug-induced SKM injury, traditional laboratory testing for SKM injury, and novel skeletal myocyte biomarkers under investigation. This can be incredibly useful in both clinical practice and for de-challenge/re-challenge investigational trials where the risk of drug-induced SKM injury is present.

Renal agenesis: A meta-analysis of its prevalence and clinical characteristics based on 15 641 184 patients.

Our objective was to analyse the newest relevant data on worldwide prevalence and associated symptoms of renal agenesis (RA). This meta-analysis builds on previous systematic reviews to include bilateral RA, its symptoms and data on gender, unilateral RA and anomaly location prevalence. Review of available data included records in English and other languages from PubMed, Embase, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect Korean Journal Database and Russian Citation Index and Google. A total of 15 641 184 patients were analysed in relation to the prevalence of RA. The pooled prevalence of RA was 0.03% (95% CI: 0.03%-0.04%). Based on 500 subjects, a pooled prevalence of 47.96% (95% CI: 31.55%-64.58%) for unilateral and 52.04% (95% CI: 35.42%-68.45%) for bilateral RA has been set. Our study presents the newest generalized findings on bilateral RA. There appears to be universal disease and symptom prevalence with minor differences between world regions, although quality of future observational research should include genomic data. This will provide even further insight into the prognosis of various renal anomalies and their etiologies.

A complete analysis of the surgical treatment for cubital tunnel syndrome: an umbrella review.

BACKGROUND: Numerous original studies have been presented regarding various surgical treatments for cubital tunnel syndrome (CubTS). The results of these analyses regarding the different surgical treatments for CubTS frequently differ and, in some cases, contradict each other, creating confusion. Therefore, our umbrella review aimed to summarize the evidence from meta-analyses and systematic reviews regarding the surgical treatments of CubTS, and along with the new, more detailed outcomes, provide an evidence-based tool for surgeons performing these procedures. MATERIALS AND METHODS: To perform this umbrella review, a systematic search was conducted for meta-analyses investigating CubTS in PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO medical databases. RESULTS: Detailed comparison of surgical outcomes, such as clinical improvement, complications, or reoperation rates, of different treatment methods for CubTS was performed. New risk ratios in all categories were established based on all of the primary studies available in the literature. DISCUSSION: The goal of the present umbrella review was to gather and summarize all data about the surgical treatments for CubTS in the available literature and provide new outcomes and an evidence-based tool for surgeons performing these procedures. Each comparison of the surgical techniques has been discussed, and the present study's results were compared with the outcomes of the previous studies.

Topographic anatomy of the submental artery and its clinical implications for reconstructive surgery.

Knowledge about the anatomy of the submental artery (SA) is of immense importance when performing plastic and reconstructive procedures. A retrospective study was performed to analyze the topographic anatomy of the SA. The measurements were performed on 80 consecutive patients who underwent head and neck computed tomography angiography (CTA). The SA was present in 131 out of 137 hemifaces (95.6%). The vessel originated from the facial artery in all cases (100.0%). Moreover, the SA was found to have 0-4 branches. However, most commonly, the said artery had no branches of considerable size (51.1%). Due to the high variability of the course of the said artery, the authors of the present study created a novel classification system presenting the most prevalent courses of the SA in the submental region. The current study utilized 131 hemifaces of 80 (CTA) to create a heat map of the SA, illustrating its precise origin and course in the submental region. The findings of this study could assist surgeons in developing a mental map of the arterial anatomy of the submental region, potentially improving the efficiency of localizing the SA and reducing the risk of complications during plastic and reconstructive procedures.

The anatomy of the uterine artery: A meta-analysis with implications for gynecological procedures.

The uterine artery (UA) is an arterial branch of the internal iliac artery in women, usually arising from the anterior division of the internal iliac artery. However, due to the high variability in the anatomy of the UA, embolization of this vessel may be challenging. Therefore, the objective of this meta-analysis was to provide physicians with transparent data on the anatomy of the UA, using the available data in the literature. Databases such as PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched to find all the relevant studies regarding the UA. A total of 16 articles met the required criteria. The UA was found to originate most frequently from the internal iliac artery as the pooled prevalence was set to be 61.72% (95% CI: 41.31%-80.31%). A pooled prevalence of the UA originating from the umbilical artery was established at 13.93% (95% CI: 2.76%-30.44%). A pooled prevalence of the UA originating from the inferior gluteal artery was set to be 5.22% (95% CI: 0.00%-15.44%). In conclusion, we believe that this is the most accurate and up-to-date study regarding the highly variable anatomy of the UA. The UA originates most frequently from the internal iliac artery (61.72%), however, other origins, such as from the umbilical artery (13.93%) or the inferior gluteal artery (5.22%) may occur. It is hoped that the results of the present meta-analysis will be a helpful tool for surgeons performing pelvic or gynecological surgeries.

The arterial anatomy of the posterior duodenum - A computed tomography angiography analysis with implications for abdominal surgery.

The main objective of the present study was to clarify the anatomical characteristics of the GDA. In order to fulfill this objective, novel classification systems of both the origin and branching pattern of the said vessel were created. Being aware of the variable anatomy of the GDA is of great importance when performing hepatopancreaticobilliary procedures. The results of 75 consecutive patients who underwent abdomen computed tomography angiography (CTA) were analyzed. A total of 74 GDA were analyzed. Of these, 42 were from women (56.8%) and 32 were from men (43.2%). The most common direction of origin of the GDA was inferior (n = 38; 51.4%). The origin variation of each GDA was deeply analyzed. Initially, eight types of origin variations were evaluated, of which types 1-3 constituted 83.8%. Furthermore, analogously, branching pattern types were also established. Initially, 11 branching variations were evaluated, of which types 1-3 constituted 87.8%. The GDA is subject to numerous variations, both in the origin and in the branching pattern of the vessel. In order to clarify the anatomical characteristics of this vessel, novel classifications of the origin and branching patterns were made, presenting the most frequent patterns. Our results may be of great use for surgeons performing hepatopancreaticobilliary surgeries, such as the Whipple procedure or vascular reconstructions after cholangiocarcinoma resections. Being aware of the anatomical variations of relevant structures associated with a surgical procedure may help reduce potential intraoperative and/or postoperative complications.

The anatomy of the atrioventricular nodal artery: A meta-analysis with implications for cardiothoracic surgery and ablation procedures.

The objective of the present meta-analysis was to evaluate recent and applicable data regarding the location and variation of the atrioventricular nodal artery (AVNA) in relation to adjacent structures. In order to minimize postoperative risks and maintain physiological anastomosis for proper cardiac function, understanding such possible variations of vascularization of the AV node is of immense importance prior to cardiothoracic surgery as well as ablations. In order to perform this meta-analysis, a systematic search was conducted in which all articles regarding, or at least mentioning, the anatomy of the AVNA was searched. In general, the results were based on 3919 patients. AVNA was found to originate only from the RCA in 82.41% (95% CI: 79.46%-85.18%). The pooled prevalence of AVNA originating only from LCA was found to be 15.25% (95% CI: 12.71%-17.97%). The mean length of AVNA was found to be 22.64 mm (SE = 1.60). The mean maximal diameter of AVNA at its origin was found to be 1.40 mm (SE = 0.14). In conclusion, we believe that this is the most accurate and up-to-date study regarding the highly variable anatomy of the AVNA. The AVNA was found to originate most commonly from the RCA (82.41%). Furthermore, the AVNA was found to most commonly have no (52.46%) or only one branch (33.74%). It is hoped that the results of the present meta-analysis will be helpful for physicians performing cardiothoracic or ablation procedures.

The complete anatomy of the lingual nerve: A meta-analysis with implications for oral and maxillofacial surgery.

Lingual nerve (LN) injury during surgical procedures in the third molar region warrants a detailed study of its common pathway and important variations. Therefore, the objective of this study was to analyze and compile the multiple anatomical variations of the LN for use in oral and maxillofacial surgery. It is anticipated that the results of the present meta-analysis may help to minimize the possible complications when performing procedures associated with this anatomical entity. Major online databases such as PubMed, Web of Science, Scopus, Embase were used to gather all relevant studies regarding the LN anatomy. The results were established based on a total of 1665 LNs. The pooled prevalence of the LN being located below the lingual/ alveolar crest was found to be 77.87% (95% CI: 0.00%-100.00%). The LN was located above the lingual/ alveolar crest in 8.21% (95% CI: 4.63%-12.89%) of examined nerves. The most common shape of the LN was established to be round with a prevalence of 40.96% (95% CI: 23.96%-59.06%), followed by oval at 37.98% (95% CI: 23.98%-53.02%) and flat at 25.16% (95% CI: 12.85%-39.77%). In conclusion, we believe that this is the most accurate and up-to-date study regarding the anatomy of the LN. The LN was found to be located below the lingual/alveolar crest in 77.87% of the cases. Furthermore, the LN was found to enter the tongue under the submandibular duct in 68.39% of the cases. Knowledge about the anatomy of the LN is crucial for numerous oral and maxillofacial procedures such as during the extraction of the third molar.

The prevalence and anatomy of the pyramidal lobe of the thyroid gland: A meta-analysis with implications for thyroid surgery.

The pyramidal lobe (PL), also known as the third lobe of the thyroid gland or lobe of Lalouette is an embryological remnant of the caudal end of the thyroglossal tract. The following meta-analysis aims to provide a detailed analysis of the anatomical variations of the PL using the available data in the literature. Major online medical databases such as PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched in order to find all studies considering the prevalence and anatomy of the PL of the thyroid gland. Finally, a total of 24 studies that met the required criteria and contained complete and relevant data were included in the present meta-analysis. The pooled prevalence of the PL was found to be 42.82% (95% CI: 35.90%-49.89%). An analysis showed that the mean length was 23.09 mm (SE: 0.56). The mean width was found to be 10.59 mm (SE: 0.77). The pooled prevalence of the PL originating from the left lobe (LL) was established at 40.10% (95% CI: 28.83%-51.92%). In conclusion, we believe that this is the most accurate and up-to-date study regarding the complete surgical anatomy of the PL. The PL was prevalent in 42.82% of the cases, being slightly more prevalent in males (40.35%) than females (37.43%). The mean length and width of the PL were 23.09 mm and 10.59 mm, respectively. Our results should be taken into consideration when performing procedures on the thyroid gland, such as thyroidectomies. The presence of the PL can affect the completeness of this procedure and lead to postoperative complications.

Synovial plica of the elbow - detailed measurements and how to implicate its relevance in clinical practice.

PURPOSE: The synovial plica of the elbow is a fold of synovial tissue, which is said to be a remnant of the embryonic septa of normal articular development and is located around the radiocapitellar joint. The objective of the present study was to provide morphometric properties of the synovial plica of the elbow and its relation to surrounding structures in asymptomatic patients. METHODS: A retrospective study was conducted to establish the morphometric characteristics of the synovial plica of the elbow. The results of 216 consecutive patients, who for different reasons during the five year period of time underwent magnetic resonance imaging (MRI) of an elbow, were analyzed. RESULTS: Plica was found in a total of 161 of 216 elbows (74.5%). The mean width of the plica was set to be 3.00 mm (SD: 1.39). The mean length of the plica was established at 2.91 mm (SD: 1.13). An analysis of sexual dimorphism was also included. Potential correlations were analyzed for each of the categories and age. CONCLUSIONS: The synovial plica of the elbow is a clinically relevant anatomical structure. Analyzing the morphometric parameters of the synovial plica is necessary to properly evaluate synovial plica syndrome, which can commonly be confused with other sources of lateral elbow pain such as tennis elbow, oppression of the radial and/or posterior interosseous nerve, or snapping of the triceps tendon. The authors suggest that the thickness of the plica may not be the golden diagnostic feature as there are no statistically significant differences in this parameter between symptomatic and asymptomatic patients. A precise and accurate diagnosis of synovial fold syndrome and/or differentiation from other sources of lateral elbow pain must be performed, as the surgical treatment, even if performed properly, will be unsuccessful because of a misdiagnosed source of pain.

Evaluation of lateral epicondylopathy, posterior interosseous nerve compression, and plica syndrome as co-existing causes of chronic tennis elbow.

PURPOSE: A great number of patients that suffer from lateral epicondylitis, commonly called tennis elbow (TE), are not successfully treated, meaning, not getting adequate therapeutic effects and the main origin of the pain not being handled appropriately. The hypothesis of the present study is that the inefficiency of the treatment of the chronic TE may often be due to underdiagnosis of posterior interosseous nerve (PIN) entrapment or and plica syndrome, as the authors believe that those pathologies can often occur simultaneously. METHODS: A prospective cross sectional study was conducted. A total of 31 patients met the required criteria. RESULTS: Thirteen (40.7%) of the patients had more than one source of the lateral elbow pain. Five patients (15.6%) had all three examined pathologies. Six patients (18.8%) had TE and PIN syndrome. Two patients (6.3%) had TE and plica syndrome. CONCLUSION: The present study demonstrated concomitant potential sources of lateral elbow pain in patients diagnosed with chronic TE. Our analysis shows how important it is to systematically diagnose patients that present with lateral elbow pain. The clinical characteristics of the three most common causes of chronic lateral elbow pain, meaning, TE, PIN compression, and plicae syndrome were also analyzed. Having adequate knowledge about the clinical aspects of these pathologies can help with a more effective differentiation of the etiology of chronic lateral elbow pain, and with that, a more efficient and cost-effective treatment plan.