ORTHOPEDICS + SPORTS MEDICINE
Elbow Arthroscopy
A small-incision approach to loose bodies, stiffness, and painful impingement inside the elbow.
The elbow contains several closely positioned bones, nerves, ligaments, and cartilage surfaces. When pain, stiffness, catching, or locking appears to originate inside the joint, elbow arthroscopy can provide a detailed view of these structures and allow certain problems to be treated during the same procedure.
Elbow arthroscopy uses a small camera and specialized instruments inserted through several small incisions. Because the elbow is compact and surrounded by important nerves and blood vessels, the procedure requires careful planning and a detailed understanding of the joint’s anatomy.
Anatomy of the Elbow Joint
The elbow is formed by three bones: the humerus in the upper arm and the radius and ulna in the forearm. These bones meet to create a joint that allows the arm to bend and straighten while also supporting rotation of the forearm.
Articular cartilage covers the ends of the bones, allowing them to glide smoothly. Ligaments stabilize the joint, while muscles and tendons generate movement. A thin tissue lining called the synovium produces fluid that lubricates the joint.
The ulnar, median, and radial nerves travel close to the elbow. Their proximity is an important consideration during any surgical procedure in this area.
Damage to the cartilage, inflammation, scar tissue, loose fragments of bone or cartilage, and bone spurs can interfere with normal motion. Patients may notice pain, stiffness, swelling, catching, locking, or a gradual loss of the ability to fully bend or straighten the arm.
Conditions Treated With Elbow Arthroscopy
Elbow arthroscopy may be used to evaluate and treat several problems inside the joint. These can include:
- Loose pieces of bone or cartilage
- Bone spurs
- Osteochondritis dissecans
- Joint stiffness and scar tissue
- Inflamed or damaged joint lining
- Certain fractures
- Early arthritic changes
- Some cases of tennis elbow
- Unexplained catching or locking
Not every elbow condition can be treated arthroscopically. Large fractures, advanced arthritis, significant deformity, or complex ligament and nerve problems may require another surgical approach.
The decision depends on where the problem is located and whether it can be safely reached through an arthroscope.
Before Elbow Surgery Is Considered
Treatment commonly begins with nonsurgical care. Rest, activity modification, medication, bracing, physical therapy, or injections may be appropriate depending on the diagnosis.
Surgery may be discussed when symptoms remain persistent, joint motion continues to decline, or loose material inside the elbow causes repeated catching or locking.
The evaluation may include X-rays to examine the bones and joint space. An MRI or CT scan may provide more information about cartilage, ligaments, loose fragments, fractures, or the shape of the joint. Nerve testing may also be ordered when symptoms include numbness, tingling, or weakness.
How Elbow Arthroscopy Is Performed
Elbow arthroscopy is generally performed under anesthesia. The arm is positioned so the surgeon can safely reach different areas of the joint.
Sterile fluid is placed inside the elbow to expand the joint and improve visibility. Several small incisions, called portals, are created at carefully selected locations. The arthroscope is inserted through one portal, sending images from inside the joint to a monitor.
Small surgical instruments can then be introduced through the remaining portals. Depending on the condition, the surgeon may:
- Remove loose bone or cartilage
- Trim damaged tissue
- Remove inflamed joint lining
- Release scar tissue
- Smooth certain bone spurs
- Evaluate cartilage and ligament damage
- Address a limited area of tendon damage
The incisions are closed after the necessary treatment is completed. Because the structures surrounding the elbow are close together, portal placement is planned to reduce unnecessary risk to the nearby nerves and blood vessels.
Recovery After Elbow Arthroscopy
Many elbow arthroscopy procedures are completed on an outpatient basis. The arm may be placed in a dressing, splint, or sling depending on what was treated.
Swelling, stiffness, and soreness are common during early recovery. Keeping the arm elevated and following instructions for incision care can help manage these symptoms. Patients should avoid lifting or placing significant stress on the elbow until cleared by the surgeon.
Recovery varies considerably because elbow arthroscopy can be used for several different procedures. Removing a small loose fragment may require less recovery than treating extensive scar tissue, cartilage damage, or a tendon condition.
Follow-up visits allow the surgeon to examine the incisions, monitor motion, and determine when work, driving, exercise, and sports can resume.
Physical Therapy and Restoring Motion
Physical therapy may be recommended to restore elbow movement and prevent stiffness. The elbow can become stiff relatively quickly, so controlled motion may begin early when it is safe for the treated tissue.
Rehabilitation may focus on:
- Restoring bending and straightening
- Improving forearm rotation
- Managing swelling
- Rebuilding arm strength
- Returning to work or athletic activities
The timing of movement depends on the specific treatment completed. A procedure involving tissue repair may require more protection than the removal of a loose body or bone spur.
When to See an Elbow Specialist
An orthopedic evaluation may be useful when elbow symptoms do not improve with rest or begin limiting routine arm movement.
Reasons to schedule an evaluation include:
- Persistent pain or swelling
- Repeated catching or locking
- Difficulty fully bending or straightening the elbow
- Pain during work, sports, or lifting
- A feeling that something is moving inside the joint
- Symptoms that remain after therapy or other conservative care
Numbness, tingling, or weakness in the hand should also be evaluated because these symptoms may involve one of the nerves traveling around the elbow.
Summary
Elbow arthroscopy allows the surgeon to examine the joint directly and treat certain problems through small incisions. Its usefulness depends on the location of the damage and the type of tissue involved.
Dr. Christopher Sforzo and Dr. Christopher Dillingham are board-certified and fellowship-trained orthopedic surgeons who perform arthroscopic procedures for elbow conditions. Contact Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine to schedule an elbow evaluation in Sarasota.