Advances in Elbow Arthroscopy
Advances in Elbow Arthroscopy
By: Garry S. Kitay, MD
Dr. Kitay has been a member of JOI since 1996 and treats all disorders of the hand, elbow, and shoulder in patients of all ages. Dr. Kitay discusses the progression of elbow arthroscopy and how there are multiple advantages using this treatment.
Elbow arthroscopy is increasingly used to treat both simple and complex disorders of the elbow. The elbow is formed by three
bones, the humerus, ulna, and radius. It is considered a “hinge joint” and is commonly affected by conditions that can lead to stiffness.
Arthroscopy is a type of procedure where specially designed instruments are introduced through small portals into a joint. This allows for minimally invasive diagnostic and therapeutic surgery. As instruments and techniques have been developed, there have been significant advances in the treatment of elbow conditions with arthroscopy.
Advantages of Arthroscopy
There are significant advantages to using arthroscopy in treating elbow conditions as opposed to the conventional “open approach”. In general, to gain access to the elbow with conventional surgery, a relatively large incision is required. Moreover, as the elbow is surrounded by extensor and flexor muscles, these have to be retracted or divided in order to reach the joint itself. The ligaments and capsule surrounding the joint also must be cut in order to visualize it. This greater amount of dissection tends to lead to more bleeding and pain post-operatively, often necessitating hospitalization for several days.
Hence, primary among the advantages of arthroscopy is its shorter rehabilitation time. Almost all elbow arthroscopy procedures can be performed on an outpatient basis. Additionally, the visualization obtained with an arthroscopeis excellent and generally exceeds that obtained through “open” surgical procedures.
Elbow arthroscopy is technically demanding. It requires meticulous technique with a keen understanding of the surrounding anatomy. Injury to the surrounding nerves and blood vessels can lead to significant complications such as numbness and weakness of the hand. This necessitates a planned and careful approach to each elbow arthroscopic procedure performed. There are multiple indications for elbow arthroscopic procedures. The one that has been recognized for the longest period of time, is the presence of loose bodies within the elbow. A patient with a loose body will commonly complain of locking, catching or snapping of the elbow. Occasionally stiffness is encountered. Following careful examination which includes measurement of the motion of the elbow and palpation for any crepitation or “catching” of the joint, x-rays are obtained. However, loose bodies may not be seen on x-rays. Occasionally, more sophisticated diagnostic studies are ordered such an MRI. Arthroscopic removal of loose bodies in the elbow is generally very successful with a quick recovery and return to normal activities.
Arthroscopic elbow synovectomy is a procedure that is performed for inflammation of the lining of the elbow joint. This is frequently seen in rheumatoid arthritis. Surgery is indicated when appropriate medications are not helpful and the elbow remains swollen, painful, and stiff. This condition is treated with specialized motorized shavers. These are used to debride or excise the abnormal proliferative synovium or joint lining tissue. This often requires multiple portals which are the small incisions permitting access to the elbow, from multiple directions so as to access the entire joint. This generally leads to a significantly more rapid recovery than when done with an open larger surgical approach.
However, physical therapy is still often helpful in recovering from this procedure. Stiffness, or contractures, of the elbow can be caused by multiple conditions but is often related to arthritis. This condition, as well, has seen advances with elbow arthroscopy where motorized burrs can be used to remove impinging spurs in order to diminish pain and improve range of motion. This procedure is usually followed by a concerted therapy program in order to regain motion and strength as soon as possible.
If you are interested in scheduling an appointment with Dr. Kitay, go to: JOIonline.net or call JOI-2000
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