Tendinopathy and Synovial Fringe Syndrome

  • Mustafa Kaynak
  • Denise Eygendaal
  • Bertram The


Lateral and medial epicondylitis are one the most frequent encountered and diagnosed musculoskeletal conditions for, respectively, lateral and medial elbow pain. Both tendinopathies are self-limiting diseases and rarely require surgical intervention. However, in a small portion of patients, symptoms persist despite adequate conservative treatment and therefore may require surgery. While synovial fringe syndrome is a less commonly diagnosed pathological elbow condition, it may significantly induce symptoms, which may mimic lateral epicondylitis (LE). Patients should be aware that surgical treatment does not guarantee full resolution of symptoms, especially with regard to epicondylitis. Reported surgical techniques include the classical open technique, the arthroscopic technique, and the fractional lengthening technique. All surgical techniques provide good outcomes with no clear evidence-based-guided preference of one technique over the other. The surgical technique performed for epicondylitis is therefore chosen at the surgeon’s preference and experience. Surgical treatment is recommended if conservative treatment does not result in adequate relief of symptoms after 6–12 months. On the other hand, arthroscopy is the preferred surgical method of treatment for synovial fringe syndrome and provides excellent outcomes. Surgery of these musculoskeletal conditions, in spite of the choice of technique, should be performed with care because of the substantial risk at neurovascular and collateral ligament injuries.


Elbow tendinopathy Lateral epicondylitis Medial epicondylitis Synovial fringe syndrome Elbow plica syndrome 




Supplementary material

Video 49.1

Open tennis elbow surgery—classical method (MP4 91002 kb)

Video 49.2

Arthroscopic removal of a synovial fringe (MP4 87330 kb)


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Copyright information

© ISAKOS 2020

Authors and Affiliations

  • Mustafa Kaynak
    • 1
  • Denise Eygendaal
    • 1
    • 2
  • Bertram The
    • 1
  1. 1.Amphia HospitalBredaThe Netherlands
  2. 2.Amsterdam University Mecical CentreAmsterdamThe Netherlands

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