Elbow Arthroscopy

INTRODUCTION

The elbow joint is a hinged joint where the upper arm bone (humerus) meets the two forearm bones (ulna and radius). The main stabilizing structure of the elbow joint is the ligament along the inner aspect of the elbow (medial collateral ligament.) The unique anatomy of the elbow joint allows it to pass through a broad range of motion. During repetitive overhead and lifting sports and occupations, the elbow experiences tremendous stress. This may lead to the formation of small loose fragments of cartilage or bone (loose bodies) or elbow joint spurs.

Arthroscopic surgery of the elbow is challenging because of the joint's anatomy. The bones lie close together, and nerves and blood vessels are located very close to the joint (see illustration). Therefore, the doctor must be especially careful when inserting the arthroscopic instruments into the joint.

Although it is a difficult procedure, arthroscopic surgery is often the ideal choice for treating certain elbow conditions. An injury or arthritis can damage the ends of the bones and cause bone spurs to develop. These spurs can be painful and make it hard to move the elbow. The doctor can remove the spurs by using special tools, such as a burr, inserted into the joint through the portals or small incisions. After the spurs are removed, the elbow moves more easily and with less pain.

Arthroscopy is a surgical procedure where optical instruments are used to visualise the inside of a joint. This can be done through very small skin incisions and then allow treatment of problems within the joint to be performed through other very small skin incisions.

Arthroscopy has dramatically altered the approach to the diagnosis and treatment of a variety of joint ailments. Arthroscopy can be used to aid in diagnosis, to determine prognosis and most importantly, to provide treatment.
Arthroscopy of most of the larger joints is an extremely safe procedure and has very few complications.

In recent years, the role of elbow arthroscopy has expanded dramatically and is becoming a much more common procedure. Elbow arthroscopy has the potential to be hazardous to important nearby nerves and vessels, more so than with most other joints. Placing the viewing telescope and instrument in the correct place and being very careful with surgical technique, significantly diminishes the risk to the structures.

There are few contraindications to elbow arthroscopy. There are many situations, however, that might make the procedure more difficult or may preclude the use of certain portals for access to the joint. This includes situations such as ulnar nerve transposition or prior surgery that alters normal elbow anatomy.

The surgery will be performed under a general anaesthetic. Once you are asleep, you will be placed on your side and the arm to be operated on will be placed over an arm holder. Multiple skin stabs will then be made to allow access of both the viewing camera and the operating instruments into your elbow joint. The joint will be thoroughly inspected and then any pathology will be treated at the time.

Elbow arthroscopy is particularly helpful for...

Removal of loose bodies.
Evaluation and treatment of OCD.
Evaluation and treatment of damaged joint lining surfaces.
Removal of bone spurs.
Synovectomy - especially for rheumatoid arthritis.
Stiff elbow release.
Tennis elbow release.
Evaluation of instability.

THE OPERATION

An elbow arthroscopy introduces an arthroscope (small 'telescope') into the elbow joint through several small 2-3 millimeter incisions.
The arthroscope is used to identify the location of the loose bodies and the spurs.
The loose bodies can be removed by using the arthroscope in addition to small grasping instruments. The bone spurs can be removed by visualizing the spur with the arthroscope and using a small burr to remove the spur.
These elbow arthroscopic procedures take about 30-90 minutes and are done on an day-case basis (without an overnight stay in the hospital).

Elbow Arthroscopy with Loose Body

Removal of Loose Body