Painful Snapping Research Articles

요골 상완골 관절의 발음성 추벽 - 증례보고 -

We experienced rare cases of Snapping plicae on radiohumeral joint which arthoscopic plicae resection improved symptom of painful snapping elbow. We report that Arthroscopy can be used as a effective therapeutic and diagnostic method for snapping plicae on radiohumeral joint with a review of its literature.

Dynamic sonography of external snapping hip syndrome.

To evaluate the dynamic sonographic findings of external snapping hip syndrome. Five patients with 7 cases of painful external snapping hip (3 male and 2 female; age range, 14-32 years; mean, 19 years) were examined with sonography. Two patients had bilateral snapping. Dynamic sonographic examinations of hips were performed with a linear 5- to 12-MHz transducer during hip motion. Dynamic sonographic studies of the affected hip revealed causes of the external snapping hip in all cases. It was elicited by an abnormal jerky movement of the iliotibial band overlying the greater trochanter in 5 of 7 cases and of the gluteus maximus muscle in 2 cases. The iliotibial band over the greater trochanter was hypoechoic in 3 of the 5 cases and thickened in 1 case. Dynamic sonography showed good correlations between the jerky movements of the iliotibial band and the gluteus maximus muscle and the painful snapping reported by the patients. Dynamic sonography was helpful in the diagnosis of external snapping hip syndrome; it showed real-time images of sudden abnormal displacement of the iliotibial band or the gluteus maximus muscle overlying the greater trochanter as a painful snap during hip motion.

SURGICAL CORRECTION OF THE SNAPPING ILIOPSOAS TENDON IN ADOLESCENTS

There have been very few reports regarding symptomatic snapping of the iliopsoas tendon, and none of those reports have dealt exclusively with an adolescent population. We report our experience with the surgical treatment of this entity in a group of patients who had an average age of fifteen years. Nine adolescent patients (eleven hips) underwent fractional lengthening of the iliopsoas tendon at the musculotendinous junction because of persistent painful snapping of the hip. A modified iliofemoral approach to the iliopsoas tendon was used. The diagnosis in all cases was made on the basis of the history and a physical examination. Plain radiographs were made for all patients to rule out an osseous intra-articular loose body. Follow-up consisted of personal interviews and physical examinations performed at least two years postoperatively. Preoperatively, all patients had audible snapping with pain localized to the anterior part of the groin. The average duration of symptoms was 2.3 years. Prior to the onset of symptoms, all but one of the patients had been involved in competitive athletic activities. Postoperatively, all patients were able to return to the preoperative level of activity without subjective weakness. The average duration of postoperative follow-up was four years. Hip-flexion strength was noted to be nearly equal to that on the contralateral side. All patients reported that they would have the operation again under similar circumstances. One patient had recurrent snapping but stated that it was less frequent and less painful than the preoperative snapping. Two patients had transient sensory loss in the anterolateral aspect of the thigh. We conclude that fractional lengthening of the iliopsoas tendon at the musculotendinous junction is an effective and safe approach for adolescent patients with persistent symptomatic snapping of the iliopsoas tendon that is unresponsive to conservative measures.

Recurrent inferior dislocation of the acromioclavicular joint: A report of two cases

J Shoulder Elbow Surg 2001;10:387-8.

Snapping plicae associated with radiocapitellar chondromalacia

Purpose: Painful snapping of the elbow joint is usually attributed to intra-articular loose bodies, instability, or medial dislocation of the triceps muscle over the medial epicondyle. We report our experience with 14 patients who were treated arthroscopically for snapping elbow that was found to be caused by hypertrophic synovial folds associated with radiocapitellar chondromalacia. Type of Study: Case series. Methods: The records of 14 patients who were treated arthroscopically for painful snapping elbows caused by intra-articular plicae were reviewed. There were 6 women and 8 men with an average age of 36 years (range, 27 to 48 years). Nine patients had had some type of trauma to the joint. Four patients had been previously diagnosed with lateral epicondylitis and 5 with intra-articular loose bodies. The average time from initial onset of symptoms to treatment was 13 months (range, 8 to 36 months). Average follow-up was 24 months (range, 6 to 66 months). Results: All patients complained of painful snapping in the posterolateral or anterolateral aspect of the elbow. The snapping occurred between 90° and 110° of flexion with the forearm in pronation. In 7 patients, the snapping was reproducible by passively flexing the pronated elbow, which we refer to as the flexion-pronation test. At the time of arthroscopic surgery, all patients had a thickened synovial plica that would snap back and forward over the radial head, usually associated with a chondromalacic area on the radial head. Twelve patients had complete relief of their snapping after surgery. One patient in whom there was associated posterolateral rotatory elbow instability did not improve. One patient became asymptomatic for 4 years but then had recurrence of her symptoms, which persisted despite 2 subsequent arthroscopies. Conclusions: The presence of synovial plicae in the radiocapitellar joint must be considered in the differential diagnosis of painful snapping elbow. Arthroscopy confirms the diagnosis and allows excision of the plica.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 5 (May-June), 2001: pp 491–495

Extraarticular snapping hip: sonographic findings.

The aim of the study was to determine the sonographic findings of snapping hip and to correlate the findings with the presence or absence of pain. Twenty patients with snapping hip were examined with sonography. Conventional and dynamic sonographic examinations of both hips were performed using a 5.0- or 7.0-MHz transducer. Conventional sonographic studies allowed identification of various structural abnormalities (tendinitis, bursitis, synovitis) and helped to document tenderness along the course of specific tendons. Dynamic sonographic studies revealed 26 cases of snapping hip. In 24 of these 26 cases, the underlying cause was clearly identified. Twenty-two snapping hips were caused by an abnormal movement of the iliopsoas tendon, and two were caused by iliotibial band friction over the greater trochanter. One patient reported a bilateral snapping sensation that could not be documented on sonography. Snapping hip was elicited by a wide variety of hip movements. Sonography established an immediate temporal correlation between the jerky tendon motion and the painful snap reported by the patient. Only 14 cases of snapping hip were painful. Conventional sonographic studies can identify signs of tendinitis, bursitis, or synovitis. Dynamic sonographic studies revealed the cause of snapping hip in most patients. Snapping hip is characterized on sonography by a sudden abnormal displacement of the snapping structure. In our study, a significant proportion of the cases of snapping hip were not painful.

Unrecognized dislocation of the medial portion of the triceps: another cause of failed ulnar nerve transposition.

Failed surgical treatment for ulnar neuropathy or neuritis due to dislocation of the ulnar nerve presents diagnostic and therapeutic challenges. The authors of this paper will establish unrecognized dislocation (snapping) of the medial portion of the triceps as a preventable cause of failed ulnar nerve transposition. Fifteen patients had persistent, painful snapping at the medial elbow after ulnar nerve transposition, which had been performed for documented ulnar nerve dislocation with or without ulnar neuropathy. The snapping was caused by a previously unrecognized dislocation of the medial portion of triceps over the medial epicondyle. Seven of the 15 patients also had persistent ulnar nerve symptoms. The correct diagnosis of snapping triceps was delayed for an average of 22 months after the initial ulnar nerve transposition. An additional surgical procedure was performed in nine of the 15 cases and, in part, consisted of lateral transposition or excision of the offending snapping medial portion of the triceps. Of the four patients in this group who had persistent neurological symptoms, submuscular transposition was performed in the two with more severe symptoms and treatment of the triceps alone was performed in the two with milder neurological symptoms. Excellent results were achieved in all surgically treated patients. Six patients declined additional surgery and experienced persistent snapping and/or ulnar nerve symptoms. Failure to recognize that dislocation of both the medial portion of the triceps and the ulnar nerve can exist concurrently may result in persistent snapping, elbow pain, and even ulnar nerve symptoms after a technically successful ulnar nerve transposition.

A Case Report of Painful Snapping Elbow due to Incarcerated Annular Ligament

A Case Report of Painful Snapping Elbow due to Incarcerated Annular Ligament

Arthroscopic partial resection of the scapula for snapping scapula: A new technique

We describe a new method of arthroscopic bony surgery to the superomedial corner of the scapula in patients with painful snapping caused by bony impingement. Seven patients who had failed conservative treatment were monitored prospectively. In 5 patients we used 3-dimensional computed tomography as a diagnostic acid. The condition was successfully managed in 6 cases. One procedure was abandoned because of intraoperative swelling; there was 1 minor wound infection. In all cases the operation relieved symptoms. Two of the 5 patients scanned had narrowing of the superomedial interval. The advantages of this technique are in cosmesis and early rehabilitation, and the early results are good. Provided due care is taken in portal placement, complications should be minimal. Three-dimensional reconstruction computed tomography scanning may be useful in some patients to show narrowing between the superomedial corner and the chest wall, but we cannot at present recommend its routine use.

Idiopathic Hip Instability

The painful, snapping hip often presents a diagnostic dilemma having many potential etiologies. An understanding of the precise cause increases the potential for successful treatment. Five patients with no prior history of significant trauma were evaluated, all of whom had longstanding painful snapping in the groin and consistent symptoms of gait disturbance and increased pain in the provocative position of hip flexion, adduction, and internal rotation. Multiple prior tests and procedures had been nondiagnostic. Simple manual longitudinal traction under fluoroscopy showed subluxation with appearance of a vacuum sign in the symptomatic hip, whereas no such finding was observed on the asymptomatic side. This strongly suggests atraumatic hip instability as a previously unrecognized cause of the painful, snapping hip. The easily obtainable diagnostic traction radiograph is described.

The snapping hip: Clinical and imaging findings in transient subluxation of the iliopsoas tendon : Janzen DL, Partridge E, Logan M, et al. (Department of Radiology, Vancouver Hospital and Health Science Centre, 855 W 12th Ave., Vancouver BC V5Z 1M9, Canada). Can Assoc Radiol J 1996;47:202–208

To define the clinical, ultrasonographic and magnetic resonance imaging (MRI) findings in patients with painful snapping of the hip secondary to transient subluxation of the iliopsoas tendon.Seven patients, ranging in age from 17 to 30 years, with a total of eight painful snapping hips were examined with static and dynamic ultrasonography and MRI during hip motion producing the painful snapping. The duration of symptoms, the level of disability and the response to therapy were recorded.Static ultrasonography showed thickening of the iliopsoas tendon (tendinitis) in two cases and a peritendinous fluid collection in two cases. In all cases dynamic ultrasonography of the iliopsoas tendon during hip motion showed distinct abnormal motion of the tendon corresponding temporally to the painful palpable and audible sensation. MRI showed normal intra-articular structures in all cases, tendinitis in two cases and iliopsoas bursitis in one case. Clinically, subluxation of the iliopsoas tendon is a chronic (mean duration of symptoms in this series, 23 months) disabling condition that may be relieved by surgical tendon release.Dynamic ultrasonography is useful for detecting transient subluxation of the iliopsoas tendon in patients with a painful snapping hip. MRI is useful for excluding intra-articular abnormalities in patients with this condition.

Surgical release of the 'snapping iliopsoas tendon'

We report 22 patients (19 women and three men) of mean age 20.8 years who had painful snapping sensations in the groin. Most were able to reproduce the click by extending the affected hip from a flexed, abducted and externally rotated position and most were tender in the adductor triangle. Plain radiographs and an arthrogram were normal. A clinical diagnosis of subluxation of the iliopsoas tendon was made. Conservative management failed in 14 patients, two of whom had bilateral pain. All 14 had surgical release of the iliopsoas tendon through a medial approach. At follow-up (mean 17 months) the click had resolved in ten hips, was occasional but painless in five and unchanged in one. The syndrome of a painful 'snapping' psoas may result in disproportionately disabling symptoms. It may be diagnosed on clinical grounds and effectively treated, when severe, by release of the iliopsoas tendon.

Surgical correction of the snapping iliopsoas tendon

Eighteen patients with 20 symptomatic hips underwent lengthening of the iliopsoas tendon for persistent painful snapping of this "internal" variety of snapping hip. We referred to the pathologic, painful snapping of the iliopsoas in the deep anterior groin as the "internal" snapping hip. This is in contrast to the more common and better-known "external" snapping that involves the greater trochanter and its overlying soft tissues. The results of our iliopsoas lengthening procedure are presented here. Lengthening of the iliopsoas tendon was accomplished by step cutting of the tendinous portion of the iliopsoas. The pathoanatomy of this poorly understood symptom complex was described in 1984 paper from this institution and is reviewed here. Iliopsoas bursography demonstrated a sudden jerking movement of the iliopsoas tendon between the anterior inferior iliac spine and iliopectineal eminence, synchronous with the patient's pain and often accompanied by an audible snap. The average preoperative duration of symptoms was 2.9 years, and the average length of postoperative followup was 25 months. All patients, except one, had a marked reduction in the frequency of snapping after tendon lengthening, and 14 of 20 hips had no snapping postoperatively. Of the six patients who had recurrence of snapping, all but one stated that this occurred much less frequently and was much less painful compared to the preoperative state. Two hips required reoperation. Postoperatively, only three patients complained of subjective weakness, and most patients were unlimited in physical activity with return to activities such as competitive football, pole vaulting, and long-distance running.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic capitolunate instability.

Twelve patients, twelve to thirty-two years old, were evaluated for complaints of chronic vague pain, weakness, and clicking in the wrist that had followed a significant but remote dorsiflexion injury to the wrist. Although a standard orthopaedic examination and plain roentgenograms of the carpus were unremarkable, a dorsal-displacement stress test done under fluoroscopic control with the radius fixed showed dorsal subluxation of the capitate out of the cup of the lunate, accompanied by a marked feeling of apprehension by the patient. This was also associated with a painful snap or click due to a sudden dorsal attitude and ulnar shift of the lunate, best elicited with the wrist in slight ulnar deviation. We believe that this condition is due to attenuation of the radiocapitate ligament resulting from prior trauma. Eleven patients were operated on. The volar radiocapitate ligament was tightened by tethering its central portion to the radiotriquetral ligament, partially obliterating the space of Poirier. Slight extension of the wrist was lost by this procedure, but the capitate could no longer be passively displaced and the lunate became stable. Using both objective and subjective criteria, six patients had an excellent result; three, good; one, fair; and one, poor. There was an average final loss of 15 degrees of extension and 19 degrees of flexion of the wrist. The average length of follow-up was four years and four months (range, twenty-four to 109 months). We concluded that insufficiency of the radiocapitate ligament after trauma to the wrist is one cause of chronic symptomatic capitolunate instability. Shortening of the radiocapitate ligament is recommended to stabilize the lunate and capitate.

Maintenance of nonsmoking behavior through self-administered wrist-band aversion therapy

Participants in the aversion treatment were instructed to focus vividly on the triggering thoughts leading to smoking each time the urge to smoke occurred. Subjects then were to self-administer a painful snap immediately using the rubber band they were wearing around their wrist and to engage in alternate behaviors such as chewing gum. Participants in a placebo treatment were instructed to wear the wrist band as a “reminder” and to engage in alternate behaviors such as chewing gum, etc. About a third of the participants never wore the wrist band either as an aversive stimulus dispenser or as a “reminder”. These people were assigned to a nonuser group in the statistical analysis. At a 1-year follow-up, a treatment effect was shown for males but not for females. One year after treatment five of the seven males in the aversion group were still abstinent, as compared to one out of seven abstinent in the placebo group and none in the nonuser group.