Plica syndrome

What is Plica Syndrome?

Plica syndrome, also known as synovial plica syndrome, is a condition that affects the knee joint. It occurs when the synovial folds in the knee become inflamed or irritated due to friction, overuse, or injury [1]. This can cause pain and discomfort in the affected area.

Causes of Plica Syndrome

Plica syndrome can be caused by various factors, including:

• Overuse or repetitive strain on the knee joint
• Injury or trauma to the knee
• Friction between the patella (kneecap) and the surrounding tissue
• Embryological remnants in the knee joint [5]

Symptoms of Plica Syndrome

The symptoms of plica syndrome can vary from person to person, but common complaints include:

• Pain and stiffness in the affected knee
• Swelling or inflammation in the knee joint
• Limited mobility or stiffness in the knee
• A palpable cord or thickened tissue in the medial parapatellar region [5]

Treatment of Plica Syndrome

The treatment for plica syndrome typically involves a combination of:

• Rest and physical therapy to reduce inflammation and improve mobility
• Anti-inflammatory medications to manage pain and swelling
• In some cases, surgery may be necessary to remove the inflamed tissue or repair any damage to the surrounding structures [12]

Prevalence of Plica Syndrome

Plica syndrome is a relatively common condition, affecting about 10% of the population at some point in their lives [11]. It is more prevalent among athletes and individuals who engage in high-impact activities.

Overall, plica syndrome is a treatable condition that can be managed with proper care and attention. If you suspect you may have plica syndrome, it's essential to consult with a healthcare professional for an accurate diagnosis and treatment plan.

Common Signs and Symptoms of Plica Syndrome

Plica syndrome, also known as plicae irritation or synovial fold syndrome, can manifest in various ways. The symptoms may vary depending on the severity and location of the affected plica.

• Knee Pain: The primary symptom of plica syndrome is pain in the knee area, which can be dull, achy, or sharp [4][9].
• Painful to Touch: Tenderness to touch in the front of the knee and on the inside of the kneecap is a common complaint [5].
• Catching or Snapping Sensation: Some people may experience a catching or snapping sensation when moving their knee, especially if the plica is inflamed [6][12].
• Limited Mobility: Inflammation of the plica can cause stiffness and limited mobility in the knee joint [7][13].
• Popping or Clicking Sounds: Plica syndrome can also be accompanied by popping or clicking sounds when the knee is moved, especially if there's an effusion present [4].

Other Possible Symptoms

In some cases, people with plica syndrome may experience additional symptoms, such as:

• Swelling in the affected area
• Redness and warmth around the knee joint
• Difficulty walking or standing for long periods
• Pain when squatting, bending, or getting up from a seated position

Important Note: It's essential to note that these symptoms can be similar to those of other knee conditions, making diagnosis challenging. A proper medical evaluation is necessary to confirm plica syndrome.

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Plica syndrome, also known as medial plica irritation, can be diagnosed through various physical tests and examinations.

• Mediopatellar Plica Test (Mital-Hayden test): This test is used to identify pain originating from the medial patellar plica. It involves applying manual force to press the inferomedial portion of the knee joint [2].
• Plica Stutter Test: This test is designed to assess for plica syndrome, but it may not be conclusive in diagnosing the condition [1]. The test involves a series of movements that mimic the action of walking or running.
• Active Extension Test: This test involves asking the patient to actively extend their knee while applying manual force to press the inferomedial portion of the knee joint. It is one of three diagnostic tests described for medial plica syndrome [8].
• Stutter Test: This test is used by doctors to assess for plica syndrome, and it involves a series of movements that mimic the action of walking or running [5].

It's worth noting that no single test can conclusively diagnose plica syndrome. A definitive diagnosis usually requires a combination of physical examination and clinical history [4]. Additionally, the diagnosis algorithm includes a carefully collected clinical history and clinical examination using specific functional tests [9].

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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are often used to treat plica syndrome

Plica syndrome treatment focuses on decreasing inflammation of the synovial capsule, and NSAIDs are a common medication used for this purpose [4]. Ibuprofen (Motrin, Ibuprin), an OTC NSAID, is useful in decreasing pain and inflammation [8]. Anti-inflammatory drugs may be of benefit in treating plica syndrome, especially when combined with therapeutic exercise and modalities [7].

Intra-plical or intra-articular corticosteroid injections can also be used

If symptoms do not improve or worsen despite initial treatment, the physician may suggest intra-plical or intra-articular corticosteroid injections [3]. This treatment option involves injecting steroids directly into the affected area to reduce inflammation.

Other medications may be prescribed on a case-by-case basis

In some cases, other medications such as local anesthetics and long-acting anti-inflammatory agents may be used in conjunction with NSAIDs or corticosteroids. For example, a steroid and a long-acting local anesthetic were tested in a series of 30 patients with medial synovial shelf plica syndrome [5].

It's essential to note that surgery is not always the first line of treatment

While surgery may be considered for cases of plica syndrome caused by trauma or specific exercises, it is unlikely to be offered as the first line of invasive treatment in many cases [7].

Differential Diagnosis of Plica Syndrome

Plica syndrome, also known as medial synovial plica syndrome, can be challenging to diagnose due to its similarity with other knee conditions. Here are some differential diagnoses that should be considered:

• Osteochondritis Dissecans (OCD): OCD is a condition where a piece of cartilage and bone breaks off from the end of a bone, often in the knee joint. It can cause pain and swelling similar to plica syndrome [5].
• Meniscus Injuries: Meniscal tears or other meniscal injuries can mimic the symptoms of plica syndrome, including pain and swelling in the knee [3].
• Patellar Injury and Dislocation: Patellar injuries or dislocations can also present with similar symptoms, such as pain and swelling in the front of the knee [3].
• Patellofemoral Joint Syndromes: Conditions affecting the patellofemoral joint, such as patellofemoral pain syndrome, can be difficult to distinguish from plica syndrome [6].
• Pes Anserine Bursitis: Pes anserine bursitis is a condition that affects the bursa in front of the knee and can cause pain and swelling similar to plica syndrome [3].

Imaging and Diagnostic Considerations

While imaging studies such as MRI or X-rays may not be able to directly diagnose plica syndrome, they can help rule out other conditions that may be causing the symptoms. A thorough history from the patient is also crucial in diagnosing medial synovial plica pathology [4].

References:

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