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Explore the relationship between RHSP and surroundings, analyzing its impact on nonoperative treatment outcomes in lateral epicondylitis.

February 25, 2026Open Access

Magnetic Resonance Imaging of Radiohumeral Synovial Plica: Prognostic Implications for Nonoperative Management in Lateral Epicondylitis

Key Points

Explore the relationship between RHSP and surroundings, analyzing its impact on nonoperative treatment outcomes in lateral epicondylitis.
Examined 8 elbow specimens through cadaveric studies
Analyzed MRI findings against histological sections
Engaged 459 lateral epicondylitis patients, divided by treatment outcome
Used logistic regression to develop prognostic models
Patients with treatment failure had larger RHSP dimensions.
RHSP syndrome prevalence was higher in treatment failure group (P < .05).
Sex, RHSP syndrome, CET tear size, LCL complexity, and muscle edema predicted nonoperative treatment failure.
Model 1 had a higher predictive accuracy (AUC 0.839) than Model 2 (AUC 0.805, P = .024).

Abstract

Background: The role of magnetic resonance imaging (MRI) in the treatment protocol of lateral epicondylitis is controversial. Purpose: To explore the relationship between the radiohumeral synovial plica (RHSP) and surrounding anatomic landmarks through cadaveric studies, perform a precise and detailed morphometric parametric analysis of RHSP using MRI in patients with lateral epicondylitis, and assess the predictive power of RHSP syndrome on the failure of nonoperative treatment. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were a total of 8 elbow specimens in this study. The MRI findings were compared with those in anatomic sections and histological preparations. A total of 459 patients with lateral epicondylitis from 3 hospitals were included and divided into a nonoperative treatment failure group (n = 138) and a nonoperative treatment success group (n = 321). The prognostic prediction model for nonoperative treatment was developed using the logistic regression method. Model 1 was based on logistic regression results, and model 2 was model 1 with the parameter of RHSP syndrome removed. Results: The RHSP is contiguous with the radiohumeral articular capsule and subtly mingles with the lateral collateral ligament (LCL) complex and common extensor tendon (CET), forming an enthesis. Furthermore, the authors found that patients in the nonoperative treatment failure group had greater RHSP dimensions and a higher prevalence of RHSP syndrome (all P < .05). In addition, sex, RHSP syndrome, size of CET tear, grade of LCL complex abnormality, and muscle edema were independent predictors of failure for nonoperative treatment. The AUC of model 1 (0.839; 95% CI, 0.796-0.881) was significantly higher than that of model 2 (0.805; 95% CI, 0.760-0.851) ( P = .024). Conclusion: The authors developed a model to predict the failure of nonoperative treatment in patients with lateral epicondylitis. Additionally, RHSP syndrome significantly improves the model's predictive capacity.

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Cite This Study

Cui et al. (Sun,) studied this question.

synapsesocial.com/papers/699e91c4f5123be5ed04f7be https://doi.org/https://doi.org/10.1177/23259671251412399

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