Painful Snapping Research Articles

Snapping Complication After Partial-Thickness Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction: A Report of 2 Cases.

A 14-year-old adolescent girl and 18-year-old man underwent right anterior cruciate ligament (ACL) reconstruction using quadriceps tendon (QT) autografts via partial-thickness harvest. While both patients initially recovered well, later they experienced a painful snapping in their knee localized to the lateral QT, just proximal to the patella. Surgical completion of the previous partial-thickness defect with imbrication provided resolution of symptoms at 4 and 9 months postoperatively, respectively. We present a snapping QT as a rare complication of partial-thickness QT harvest for ACL reconstruction. Surgical completion of the partial-thickness defect with imbrication resolved the snapping sensation in these two cases.

Intermittent flexor hallucis longus dislocation: ultrasound findings.

We report a case of intermittent dislocation of the flexor hallucis longus at its passage in the retro-malleolar area, related to a post-traumatic detachment of the retrotalar pulley from the medial tubercle of the talus. High-resolution ultrasound depicted the anterior dislocation of the tendon during dynamic stress, by asking the patient to flex his hallux against the examiner resistance, with the ankle in slight dorsiflexion. The tendon normally relocated after the dynamic maneuver. Tendon dislocation was associated with a painful snap.

Snapping Wrist From Bowstringing of the Digital Flexors After Carpal Tunnel Release: A Case Report.

Symptomatic bowstringing of digital flexor tendons is a rare complication of carpal tunnel release (CTR). Two weeks after open CTR, a 47-year-old man with severe carpal tunnel syndrome had relief of his preoperative median paresthesia but complained of new-onset painful snapping of the wrist and transient ulnar paresthesia occurring with wrist dorsiflexion and concomitant digital flexion. Physical examination localized the audible snapping to the hook of hamate (HOH) where manual pressure eliminated the wrist motion-induced snapping and the associated ulnar paresthesia. Wrist radiographs showed stage III scapholunate advanced collapse (SLAC) with marked palmar subluxation of the lunate. Wrist magnetic resonance imaging revealed palmar and ulnar subluxation of the digital flexors over the HOH due to the mass effect of the palmarly displaced lunate and the chronic carpal malalignment. The snapping wrist and accompanying ulnar paresthesia resolved after HOH excision, and no additional treatment for the asymptomatic SLAC wrist deformity was required. Satisfactory clinical outcome was observed at 5-year follow-up.

Multifid Iliopsoas Tendons Are More Common in Patients With Painful Snapping Iliopsoas Tendons

To retrospectively determine the prevalence of multifid tendons in a population of patients who underwent iliopsoas release for painful snapping iliopsoas tendons. Patients who underwent iliopsoas release for painful snapping iliopsoas tendons were retrospectively identified from a database of patients who had undergone arthroscopic hip surgery performed by a single surgeon between 2011 and 2020. Patients who had incomplete data or who underwent prior fracture fixation, joint arthroplasty, pelvic surgery, or other interventions for snapping hip were excluded. Magnetic resonance imaging (MRI) and operative reports were reviewed and compared with those of an age-matched control group of patients who had undergone hip or pelvic MRI examinations in the past year for different indications. This study included 91 patients (78 female and 13 male patients; mean age, 23.3 years) who were treated operatively for painful snapping hip and 78 controls (54 female and 24 male patients; mean age, 28.4 years) who received hip or pelvic MRI for other indications. Among the patients who underwent iliopsoas release, there were 5 unifid iliopsoas tendons (5.5%) compared with 86 multifid iliopsoas tendons (94.5%) when classified with MRI whereas operative examination showed 19 unifid tendons (20.9%) compared with 72 multifid tendons (79.1%, P < .001). When the MRI scans of the operative group were compared with the MRI scans of the control group, the patients who underwent surgery for painful snapping hip had a higher rate of multifid tendons (94.5% of operative hips compared with 69.2% of control right hips [P< .001] and 74.4% of control left hips [P < .001]). However, when the operative reports were used to classify the iliopsoas tendon, there was no significance between the operative and control groups (79.1% of operative hips had multifid tendons compared with 69.2% of control right hips [P= .141] and 74.4% of control left hips [P= .464]). For patients with symptomatic snapping hip undergoing iliopsoas lengthening, multifid iliopsoas tendons are more prevalent than in a control population. Level IV, prognostic case series.

Intraoperative Biceps/Brachialis Stimulation for Snapping Triceps With Ulnar Neuritis.

Snapping of the triceps muscle occurs when a portion of the medial head dislocates over the medial epicondyle with elbow flexion. Resection or redirection of a portion of the triceps muscle is the main surgical treatment. The extent of triceps resection/redirection is difficult to evaluate. A novel intraoperative technique, stimulating the musculocutaneous nerve, to simulate active elbow flexion is proposed to help ensure that the snapping triceps has been adequately treated. A patient presented with a several year history of bilateral elbow pain, snapping, and ulnar nerve (UN) paresthesias. Previous staged bilateral subcutaneous UN transpositions were performed at another institution for documented UN dislocation and neuritis. Postoperatively symptoms of painful snapping persisted. Bilateral snapping triceps was diagnosed. The left elbow was reoperated. Intraoperative electrical stimulation of the musculocutaneous nerve was performed to reproduce the snapping triceps. Activation of the biceps/brachialis muscles produced powerful elbow flexion, allowed direct visualization of the forceful snapping triceps, and helped assess the adequacy of muscle resection/redirection. Intraoperative biceps/brachialis stimulation can potentially help determine how much triceps muscle should be resected/redirected to treat patients with snapping triceps.

Symptoms, Diagnosis, and Treatments of Stenosing Tenosynovitis

Sports injuries frequently occur to the hand and wrist, and one of the most common illnesses of the hand and wrist is stenosing tenosynovitis. This report concentrated on stenosing tenosynovitis, encompassing hand and wrist anatomy, high-risk groups and activities, diagnosis, conservative treatment, surgery, traditional Chinese treatment, and post-operative precautions. A high prevalence of stenosing tenosynovitis has been linked to specific sports, occupations, lifestyles, genes, illnesses, and females. The most noticeable clinical symptom is a brief blocking of the fingers during flexion, followed by painful snapping during extension. Auxiliary apparatus such as MRI, ultrasound, and goniometer, as well as specific testing for De Quervain tenosynovitis, are the two basic commonly used diagnostic techniques. Conservative treatment, surgery, and traditional Chinese medicine are options for treating stenosing tenosynovitis. Conservative treatment includes orthoses, steroid injections, and NSAIDs. Surgery involves open release and percutaneous procedures, and the major modalities of Chinese medicine are acupuncture and moxibustion, needle knives and massage. After being successfully treated, the prognosis findings could be influenced by lifestyle, psychological changes, environment, and exercise.

Rare case of intra-articular biceps incarceration following traumatic massive rotator cuff tear

Rare case of intra-articular biceps incarceration following traumatic massive rotator cuff tear

Triggering Thumb Is Not Always a Trigger Thumb

Although rare, the thumb can trigger because of de Quervain disease. An 18-year-old woman presented with painful triggering during thumb movements. Physical examination revealed locking upon thumb extension and painful snapping upon thumb flexion, with tenderness over the first extensor compartment. During the ultrasonography examination, the extensor pollicis brevis tendon snapped with a jerky movement. According to intraoperative active movement under wide-awake local anesthesia no tourniquet, only the extensor pollicis brevis tendon subcompartment was released, and the snapping was resolved. The patient was symptom-free at the second postoperative week control. Triggering because of de Quervain tenosynovitis is a rare condition, and surgical release is required in most cases. Dynamic ultrasonography is an effective tool for precise preoperative assessment of pathology and assists surgical planning. Surgery under wide-awake local anesthesia no tourniquet is advised, which helps intraoperative assessment of pathology and ensures accurate treatment.

Snapping pes anserinus – A case report

We report a case of painful snapping pes anserinus. A 21-year-old man presented with medial knee pain. After arthroscopy for medial partial meniscectomy the pain persisted. After failed conservative treatment with physical therapy surgery was performed. The pes anserinus was released, but the pain persisted. After a revision surgery with further release of the pes the symptoms disappeared. Wir berichten über einen Fall von schmerzhaftem Schnappen am Pes anserinus. Ein 21-jähriger Mann präsentiert sich mit medialen Knieschmerzen. Nachdem eine Arthroskopie mit medialer Teilmeniskektomie durchgeführt wurde, blieb der Schmerz bestehen. Nach erfolgloser konservativer Therapie mit Physiotherapie wurde ein Pes anserinus Release durchgeführt, allerdings blieben die Schmerzen bestehen. Nach einer erneuten Operation mit Revision und weiterem Release des Pes verschwanden die Symptome.

Treatment and Rehabilitation for Ruptured Flexor Digitorum Profundus Tendon after Steroid Injection in Trigger Finger and Carpal Tunnel Syndrome

The authors report cases of treatment and rehabilitation for flexor digitorum profundus (FDP) tendon rupture of the little finger in patients with history of steroid injection. In case 1, a 43-year-old man had been given two local corticosteroid injections on the palm over 8 weeks due to trigger finger of his left little finger. While doing chin-ups 1 week after the last injection, he experienced a painful snapping in his left little finger and lost flexion of the distal interphalangeal (DIP) joint. In case 2, a 49-year-old man had been diagnosed with ipsilateral carpal tunnel syndrome and was given local corticosteroid injection on the wrist. Two months after the injection the patient experienced sudden loss of flexion on the DIP joint of his left little finger while playing golf. During operation, an intratendinous rupture of the FDP tendon of the little finger was present and direct tendon repair was done in both patients. Continuous splint remolding was performed according to the range of motion. The range of motion was checked continuously at the ward and outpatient clinic every week. The final results of treatment were checked 6 months after surgery by the criteria developed by Strickland and Glogovac in 1980.

Surgical interventions for external snapping hip syndrome

PurposeSnapping hip is a common clinical condition, characterized by an audible or palpable snap of the hip joint. When the snap is perceived at the lateral side of the hip, this condition is known as external snapping hip or lateral coxa saltans, which is usually asymptomatic. Snapping hip syndrome (SHS) refers to a painful snap, which is more common in athletes who require increased hip range of motion. The aim of this article is to review the most common endoscopic techniques for the treatment of ESHS, as well as their results and limitations.MethodsThis is a review of the current literature of endoscopic surgical procedures and of the results of the treatment of external snapping hip syndrome.ResultsThe pathogenesis of SHS is mechanical. The initial treatment attempt is conservative, and usually provides good results. Patients who do not respond to conservative management are candidate for surgery. The endoscopic release of the ilio-tibial band or the endoscopic release of the femoral insertion of the gluteus maximum tendon is the most popular technique.ConclusionEndoscopic techniques provide fewer complications compared to open surgery, a lower recurrence rate and good clinical outcomes. More comparative studies with a longer follow-up are required to adequate evaluate the full role of endoscopic techniques in periarticular hip surgery.Level of evidenceLevel V.

Synovial plica of the elbow and its clinical relevance.

A synovial plica (fold) is normal anatomic finding, and occurs in 86–100% of cases; however, symptomatic plica is much less common (7.2–8.7% of all elbow arthroscopies).Synovial plica syndrome is a painful elbow condition related to symptomatic synovial plica.Synovial plica syndrome is diagnosed by clinical examination (lateral elbow pain) commonly accompanied by local tenderness, pain at terminal extension and/or painful snapping.Synovial plica syndrome may be mimicked by other elbow conditions, commonly tennis elbow, loose bodies, and degenerative arthritis.Magnetic resonance imaging or ultrasound scan may support diagnosis in correlation with clinical findings, but symptomatic plica may also be diagnosed as unexpected during elbow arthroscopy.The arthroscopic resection is effective and safe if conservative treatment fails.Cite this article: EFORT Open Rev 2020;5:549-557. DOI: 10.1302/2058-5241.5.200027

Iliopsoas Tenotomy During Hip Arthroscopy: A Systematic Review of Postoperative Outcomes

Background: Arthroscopic iliopsoas tendon release is a surgical treatment option for painful snapping hips, although it has been associated with controversy surrounding potential complications including decreased hip flexion strength, iatrogenic hip instability, and iliopsoas atrophy. Purpose: To systematically assess the efficacy and safety of arthroscopic iliopsoas tenotomy during hip arthroscopic surgery as an intervention for painful snapping hips. Study Design: Systematic review; Level of evidence, 4. Methods: A total of 3 online databases (Embase, PubMed, and MEDLINE) were searched from database inception until September 2019 for studies investigating iliopsoas tenotomy during hip arthroscopic surgery. Studies were screened by 2 reviewers independently and in duplicate, and studies investigating arthroscopic iliopsoas tendon release were included. Demographic data as well as data on treatment success, functional outcome scores, and radiological outcomes were recorded. A risk of bias assessment was performed for all included studies. Results: Overall, 21 studies were identified with a total of 824 patients (875 hips). These patients were 82.5% female (680/824), with a mean age of 28.1 years (range, 12-62 years) and mean follow-up of 32.1 months (range, 3-73 months). Arthroscopic iliopsoas tenotomy was performed at the level of the labrum in 811 hips (92.7%) or the lesser trochanter in 64 hips (7.3%). The overall reported success rate of the procedure in resolving snapping hips was 93.0% (266/286), and all studies reported an improvement in functional outcome scores. Only 6 studies (93 hips) discussed postoperative hip flexion strength, with complete recovery of strength reported in 4 studies (47 hips) and mild decreases reported in the other 2 studies (46 hips). Iliopsoas atrophy was evaluated radiologically (3 studies; 66 hips) and was found postoperatively in 92.4% (61/66) of hips. No major complications were reported. Conclusion: Arthroscopic release of the iliopsoas tendon was effective in alleviating pain and persistent clicking associated with a snapping hip. Although patients demonstrated some early postoperative weakness and iliopsoas atrophy on radiological imaging, the results from studies to date showed satisfactory clinical function and return to sports/activities. High-quality comparative studies are needed to further assess arthroscopic iliopsoas tendon release to determine the optimal technique and location of tendon release.

Surgical treatment of snapping triceps syndrome

Treatment of apersistently painful snapping triceps and possibly snapping ulnar nerve. Snapping triceps. General surgical risks. Following the anterior transposition of the ulnar nerve (subcutaneously or submuscular), the snapping portion of the triceps tendon is transsected and reinforced, and transposition of the medial triceps margin into the central triceps portion is carried out. Cast for 5-7days; for atotal of 6weeks functional exercise without maximum flexion and resistance exercise of the triceps. Weight loading after 3months. In the case presented, complaints were absent after 3months. Full load exercise, e.g., push-ups, was achieved 4months after surgery. There was no recurrent snapping within the first year. The results of this case are in agreement with the 25patients previously reported in the PubMed literature. Recurrence, gross restrictions of movement, and complications were not observed in patients who underwent surgery.

A Simple and Inexpensive Management for Peroneus Longus Dislocation

Introduction:Peroneal longus dislocation is an uncommon sports injury and commonly misdiagnosed. Imaging measure includes plain radiography, ultrasonography, and MRI examination. Treatment strategies include controversial nonoperative treatment with a significant failure rate and several surgical procedures were reported. We reporting a chronic peroneal longus dislocation case in our hospital.Material and methods:Twenty-two years old male presented with a painful snapping lateral ankle suffered 3-month prior surgery. He played futsal and suddenly he felt popped on his ankle followed by pain and swelling. Dynamic ultrasound examination shows dislocation of peroneal longus tendon and convex shape of the retromalleolar groove. A five-centimeter long incision is made posterior to the lateral malleolus and during exploration we confirmed the ultrasound findings. We perform retromalleolar groove deepening by making bone flap medially, curette the cancellous bone and tamper back the bone flap, followed by superior peroneal retinaculum (SPR) reconstruction to the medial aspect of lateral cortex of the lateral malleolus to provide smooth gliding surface. We immobilize the ankle with a cast for six weeks for soft tissue healing.Result:After six weeks he can perform the almost full range of motion of the ankle without pain. Followed by further physiotherapy to regain full range of motion of the ankle. He returns to sport six months after surgery. Ultrasound examination shows the stability of the peroneal longus tendon.Conclusion:Dynamic ultrasound examination and retromalleolar groove deepening with SPR reconstruction are simple and inexpensive management for peroneal longus dislocation

Ultrasound Features of Trigger Finger: Review of the Literature.

Trigger finger is a common pathologic condition of the digital pulleys and flexor tendons in the hand. The key clinical finding is a transient blockage of the digit when it is flexed with subsequent painful snapping when it is extended. Imaging is a helpful guide for establishing the severity of the disease, identifying the underlying cause, and deciding the appropriate management. This narrative review aims to recall the anatomic and pathologic bases and describe the ultrasound features of trigger finger, also including common ultrasound findings and complications after therapy. Ultrasound enables an accurate static and dynamic evaluation of trigger finger as well as a comparison with the adjacent normal digits and thus should be considered the radiologic modality of first choice for its diagnosis.

Midterm Outcomes of Iliopsoas Fractional Lengthening for Internal Snapping as a Part of Hip Arthroscopy for Femoroacetabular Impingement and Labral Tear: A Matched Control Study

To report minimum 5-year outcomes and rate of painful snapping resolution for patients who underwent iliopsoas fractional lengthening (IFL) as a part of hip arthroscopy for femoroacetabular impingement (FAI) and labral tear. In addition, to match this group to a group of patients who underwent hip arthroscopy for FAI and labral tear without internal snapping. Patients were eligible for inclusion if they underwent hip arthroscopy for treatment of FAI and labral tear with concomitant IFL for painful snapping and had preoperative baseline scores for modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Subscale, and visual analog scale for pain. The exclusion criteria for this study were preoperative Tönnis grade >0, active workers' compensation claims, or previous ipsilateral hip conditions. These patients were matched to a control group of patients who did not have snapping or undergo IFL but who otherwise satisfied the same inclusion and exclusion criteria. There were 57 eligible cases (80.3% follow-up). Mean follow-up time was 69.3months (from 60.0 to 91.9). All patient-reported outcomes measures demonstrated statistically significant improvements between preoperative and latest follow-up scores for the following measures (P<.001): modified Harris Hip Score (from 64.3 to 84.9), Nonarthritic Hip Score (from 61.7 to 85.2), Hip Outcome Score-Sports Subscale (from 47.0 to 75.0), and visual analog scale (from 6.5 to 2.2). Mean satisfaction was 8.1 out of 10. Painful snapping was resolved in 80.7% of cases. Ten hips (17.5%) required secondary arthroscopy at a mean of 30.5months. Three hips (5.3%) required total hip arthroplasty at a mean of 57.5months. One case (1.8%) had minor postoperative complications. There were no statistically significant differences between the groups in outcomes, complications, and secondary surgeries. IFL as part of hip arthroscopy for treatment of FAI and labral tears demonstrated similar favorable improvement, complication rates, and secondary surgeries, when compared with a control group that did not undergo IFL. Level III, retrospective comparative study.

Surgical Repair of Dynamic Snapping Biceps Femoris Tendon

A snapping biceps tendon is an infrequently seen and commonly misdiagnosed pathology, leaving patients with persistent symptoms that can be debilitating. Patients will present with a visible, audible, and/or painful snap over the lateral aspect of their knee when performing squats, sitting in low seats, or participating in activities with deep knee flexion. A thorough knowledge of the anatomy is essential for surgical treatment of this pathology, which is caused by a detachment of the direct arms of the long and short heads of the biceps femoris off the fibular styloid. This Technical Note provides a diagnostic approach, postoperative management, and details of a surgical technique to treat a snapping biceps tendon with an anatomic repair of the long and short head attachments of the biceps femoris to the posterolateral fibular styloid.

Intrasheath Instability of the Peroneal Tendons: Dynamic Ultrasound Imaging.

Peroneal intrasheath instability is a painful snapping condition of the lateral ankle. It consists of a transient retromalleolar subluxation of the peroneal tendons without disruption of the superior peroneal retinaculum or evidence of a previous definite trauma. In type A intrasheath instability, the peroneus longus and brevis tendons are intact, and there is an intertendinous intrasheath switch. In type B intrasheath instability, the peroneus brevis tendon has a longitudinal split tear through which the peroneus longus subluxates. Both types can be missed on a physical examination because there is no displacement of the peroneal tendons over the lateral malleolus. Dynamic ultrasound is the imaging modality of choice for evaluating retromalleolar subluxation of the peroneal tendons. This review article aims to provide an overview of the anatomic basis for peroneal intrasheath instability and provide physicians with guidelines for its ultrasound assessment.

Snapping elbow-A guide to diagnosis and treatment

AIMTo develop practical guidelines for diagnosis and treatment of the painful snapping elbow syndrome (SE).METHODSClinical studies were searched in the databases PubMed and Scopus for the phrases “SE”, “snapping triceps”, “snapping ulnar nerve” and “snapping annular ligament”. A total of 36 relevant studies were identified. From these we extracted information about number of patients, diagnostic methods, patho-anatomical findings, treatments and outcomes. Practical guidelines for diagnosis and treatment of SE were developed based on analysis of the data. We present two illustrative patient cases-one with intra-articular pathology and one with extra-articular pathology.RESULTSSnapping is audible, palpable and often visible. It has a lateral (intra-articular) or medial (extra-articular) pathology. Snapping over the medial humeral epicondyle is caused by dislocation of the ulnar nerve or a part of the triceps tendon, and is demonstrated by dynamic ultrasonography. Treatment is by open surgery. Lateral snapping over the radial head has an intra-articular pathology: A synovial plica, a torn annular ligament or a meniscus-like remnant from the foetal elbow. Pathology can be visualized by conventional arthrography, magnetic resonance (MR) arthrography, high resolution magnetic resonance imaging (MRI) and arthroscopy, while conventional MRI and radiographs often turn out normal. Treatment is by arthroscopic or eventual open resection. Early surgical intervention is recommended as the snapping can damage the ulnar nerve (medial) or the intra-articular cartilage (lateral). If medial snapping only occurs during repeated or loaded extension/flexion of the elbow (in sports or work) it may be treated by reduction of these activities. Differential diagnoses are loose bodies (which can be visualized by radiographs) and postero-lateral instability (demonstrates by clinical examination). An algorithm for diagnosis and treatment is suggested.CONCLUSIONThe primary step is establishment of laterality. From this follows relevant diagnostic measures and treatment as defined in this guideline.