Arthroscopic Elbow Surgery: Diagnosis and Treatment

Elbow arthroscopy involves the use of fiber optics and a tiny camera for the diagnosis and treatment of many elbow conditions. With this procedure, small incisions are made around the elbow joint to allow the camera to show a magnified picture on a TV monitor in the operating room. When the surgery is done to treat a diseased or injured joint, the orthopedic specialist inserts tiny surgical instruments through the incisions to make the necessary repair.

Because elbow arthroscopy uses smaller incisions and the joint is not open and exposed, there is minimal injury to the surrounding soft tissues. What's more, this technique allows the orthopedic surgeon to view inside the elbow joint from a variety of angles, allowing for a thorough evaluation and more appropriate treatment regimen.

What is Done Before the Procedure?

Before the surgeon performs your elbow arthroscopy, he will examine your elbow, discuss your history, and usually obtain x-rays of the joint. He may then obtain special imaging (CT scan, MRI scan) to help in diagnosis and planning. These images allow him to obtain information about the soft tissues that surround the bones. These tissues include cartilage, tendons, and ligaments. Sometimes, the bones themselves have irregularities such as spurs or extra growths that could lead to inflammation and pain. Placement of the incisions is guided by these test findings and they are an important part of your treatment plan.

What Conditions are Treated with Elbow Arthroscopy?

Elbow arthroscopy is used as a diagnostic and treatment measure for stiffness, loss of motion, and pain of the joint. Some conditions that are diagnosed include:

Adhesions - soft tissue bands that permit full motion
Injuries - fractures and torn or degenerative tissues (e.g. tennis elbow)
Contracture - problem where the tissues are contracted, limiting range of motion
Loose bodies - bone fragments and pieces of cartilage
Arthritis - a disease that involves the wearing away of cartilage that is necessary for the bones to glide smoothly against each other

How Does the Doctor Perform Elbow Arthroscopy?

Elbow arthroscopy is usually done using general anesthesia (put you to sleep). After you receive adequate anesthesia, the orthopedic specialist will create incisions known as 'portals' that allow him to gain access to the elbow joint. These portals are put in exact locations that help minimize the potential for swelling and complications. The small camera is placed through one of these incisional portals while the instruments go in others to repair and correct the condition.

The length of the procedure will vary depending on what the surgeon has to do. After the operation, the surgeon will put you in a soft bandage and splint to support your surgical site. Most patients work with our physical therapist following the procedure to regain maximum range of motion and strength of the joint. The length of your rehabilitation will depend on the extent of damage to your joint, the procedure performed, and how healthy you are going into surgery.

What are Some Reasons for Getting Elbow Arthroscopy?

Not all conditions of the elbow are treatable with arthroscopy. Some of the reasons the orthopedic specialist will perform an arthroscopic elbow surgery include:

Removing Loose Debris - The elbow joint can accumulate loose cartilage or other debris as a result of injury or arthritis. These loose bodies within the joint can cause limited range of motion, stiffness, and pain. Arthroscopic elbow surgery is a minimally invasive way to remove this difficult debris.

Removing Bone Spurs - Bone spurs can form in early stages of elbow arthritis, and these growths impede normal motion of the joint. An arthroscopic elbow procedure may be appropriate to remove the growths to eliminate pain and restore more normal motion of the elbow joint.

Thrower's Elbow - A specific elbow problem known as 'thrower's elbow' occurs in athletes such as baseball pitchers who throw a lot. Because of the tremendous forces on the elbow, a bone spur can form in the back of the joint and this leads to inflammation and pain. If nonsurgical treatments fail to relieve these symptoms, an elbow arthroscopy may be helpful to remove this growth and restore use of the joint.

Loosening the Joint Capsule - The elbow joint is notorious for stiffening as a result of surgery, injury, or other trauma to the joint. This condition is called elbow arthrofibrosis. With this condition, the elbow joint capsule may become so tight that motion is decreased and limited. Surgically loosening the joint capsule is possible in some of these patients. The advantage of an arthroscopic approach is that less scar tissue is likely to form after the procedure making the chance of regaining motion highly probable.

Assessing Cartilage Damage - Many cartilage problems are the result of osteochondritis dissecans (OCD). This leads to problems with the mobility of the elbow joint. X-rays and MRIs may not adequately show the extent of the damage, so arthroscopic surgery can be used to assess the extent of cartilage damage and determine if further treatment is necessary.

Tennis Elbow - This condition occurs when there is microscopic tearing of the tendons on the outside of the elbow joint. Many people improve without surgery, however, some do not and surgery is required. The traditional arthroscopic procedure detaches the tendon from the bone, removes the damaged tissue, followed by a repair or reattachment of the tendon.