Advances in Elbow Arthroscopy

By Dr. Garry Kitay, Orthopedic Surgeon

Advances in Elbow Arthroscopy

Elbow arthroscopy is used to treat both simple and complex disorders of the elbow. The elbow is made up of 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 procedure where specially designed instruments are used through small portals into a joint. This allows for minimally invasive diagnostic and therapeutic surgery. As instruments and techniques evolve, there have been significant advances in the treatment of elbow conditions with arthroscopy.

Advantages of Elbow 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, it requires a large incision. Moreover, the extensor and flexor muscles surround the elbow.  The surgeon must retract or divide these muscles 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. This is often the reason for 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 arthroscope is excellent and generally exceeds those with “open” surgical procedures.

When is Elbow Arthroscopy Used?

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.  Complications like numbness and weakness of the hand. This necessitates a planned and careful approach to each elbow arthroscopic procedure.

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 or catching of the elbow. Occasionally stiffness can occur.  Following a careful examination, which includes measurement of the motion of the elbow and palpation for any catching, x-rays are obtained. However, loose bodies may not be seen on x-rays. Occasionally, I will order more sophisticated diagnostic studies such an MRI. Arthroscopic removal of loose bodies in the elbow is generally very successful with a quick recovery and return to normal activities.

Synovectomy with Elbow Arthroscopic Surgery

Arthroscopic elbow synovectomy is a procedure for the inflammation of the lining of the elbow joint. This is frequently seen in rheumatoid arthritis. Surgery is needed when appropriate medications are not helpful and the elbow remains swollen, painful, and stiff.  Specialized motorized shavers allow us to treat this condition.  Shavers debride or excise the abnormal synovium or joint lining tissue. This often requires multiple portals.  Portals which are the small incisions permitting access to the elbow, from multiple directions. As a surgeon, I am able to access the entire joint. This generally leads to a more rapid recovery than when done with an open 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 remove impinging spurs in order to diminish pain and improve range of motion. This procedure needs a concerted therapy program in order to regain motion and strength as soon as possible.

To Learn more about arthroscopy watch this video from The Jacksonville Orthopaedic Institute: What is Arthroscopy?

Related Articles: Shoulder Arthroscopy and How To Get Rid of Tennis Elbow.

 

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.  In this article discusses the progression of elbow arthroscopy and how there are multiple advantages using this treatment.

To schedule an appointment with Dr. Kitay, go to: JOIonline.net or call 904-JOI-2000.

To schedule an appointment for physical or occupational therapy, call 904-858-7045 or call any of the 12 area JOI Rehab Centers.