Systematic Review and Meta-analysis of Management of Snapping Triceps Syndrome

Abstract

Introduction: Snapping triceps syndrome is a rare cause of medial elbow pain. It is a condition in which the distal portion of the triceps dislocates over the medial epicondyle during flexion and extension of the elbow. Treatment varies from excision the luxated part of the triceps, Lateral transposing the luxated part of the triceps, and distal humeral osteotomy. Aim of work: The aim of this systematic review and meta-analysis is the critical appraisal of the studies that discuss the management of snapping triceps syndrome, with the main focus being on number of cases, patient characteristics, patients reported functional follow up. Patients and methods: 3230 Records were identified through database searching. No additional records were identified through other sources. After deduplication, 492 records were screened by title and abstract. 455 records were excluded for non-eligibility and the remaining 37 records were assessed for eligibility through examination of the full-text articles. 24 Full-text articles were excluded; 18 were review articles, 2 were conference abstracts and 4 articles were irrelevant. 13 Articles were included in systematic review, all of which were also included in quantitative synthesis (meta-analysis). A PRISMA flow chart shows the details of the search results. Results: The mean age of patients with snapping triceps was 32 years, ranging from 9 - 65 years with male to female ratio of 6.5:1. Ultrasound was the imaging modality of choice of some as can be used as a dynamically to differentiate between a snapping medial triceps and a subluxing medial nerve. It was reported that conservative treatment can be attempted with NSAIDS and avoidance of provoking activities for 3-6 months, but results of it were not reported. The snapping triceps were mainly treated by Lateral transposing the luxated part or Excision the luxated part of the triceps muscle, with or without ulnar nerve transposition. The rate of excellent clinical outcome after triceps lateral transposition was 87% (95% CI = 72% to 101%). The rate of recurrence after triceps lateral transposition was 15% (95% CI = 0% to 30%). The rate of excellent clinical outcome after triceps excision was 86% (95% CI = 74% to 99%). The rate of recurrence after triceps excision was 14% (95% CI = 1% to 26%). Conclusion: there are no significant differences between lateral transposition of the luxated part of the triceps muscle & excision of the luxated part of the triceps muscle for surgical management of Triceps snapping syndrome.According to literature, we recommend Lateral transposition for large luxated part of the triceps muscle of snapping while Triceps excision for small luxated part of the triceps muscle of snapping.