Home Elbow Elbow arthroscopy

Elbow Arthroscopy

 PDF Print E-mail
Written by Garotta Lorenzo   

Advertise - Pubblicitè - Pubblicità

Arthroscopy of the elbow (click for image) is a surgical procedure that allows much simpler post-operative care following what are actually very difficult interventions. This is due to the fact that post-operative rehabilitation is easier and less painful compared to conventional “open” surgery. Many diseases can be treated with arthroscopy: stiff elbow, removal of loose bodies, sequelae of dislocation, infection, epicondylitis. Arthroscopic treatment is actually well codified for each condition.


History 
Elbow arthroscopy often has a bad reputation because the articulation is difficult to explore. However improved anatomical knowledge combined with arthroscopic technology has allowed standardization of this technique for many indications. 
The first publications (1) in the thirties mention the joint as being impossible to explore. 50 years later (80s), publications still refer to complications rather than results (2-3-4). Only more recently during the years 1990-2000, thanks to studies by Bernard Morrey and O'Driscoll (5), is knowledge of elbow arthroscopy spreading - especially on limiting the risks associated with this procedure. 


Surgical anatomy of the elbow.
The median nerve and vessel are separated from the articulation by the brachialis muscle (which should remain the absolute limit if capsulectomy is performed by arthroscopy). 
The ulnar nerve is located next to the posterior medial capsule.
The radial nerve lies in front of the radial head, not too far from incision on the anterior side.

 

Surgical technique and arthroscopy.

The patient is placed in a lateral position. The advantage over the prone position is easy access to the airway by the anaesthetist. Anatomical landmarks can be drawn before incision. Most of the procedure is performed under general anesthesia for patient comfort.

To limit the risk of vascular and nervous injuries, some recommendations are: with the elbow flexed at 90 °, the joint is filled with saline. This helps to push away the radial nerve. A small incision with a blade size eleven is made only in the skin to prevent a neuron: access is completed with a Kelly clamp, after the superficial incision. Use of intra-articular retractors improves visibility; check all instruments under the control of view before turning them on and guide them in the opposite position in relation to the nerves. Avoid aspiration with a shaver, if the work is done near the nerve structures. Take time before resection of the capsule near the nerves. In patients already operated on the ulnar nerve, it seems logical to explore the ulnar nerve in “open surgery”.

 

 


Rehabilitation and Physiotherapy 

Rehabilitation of elbow surgery is crucial to obtain a good result and is performed according to well codified protocols. Generally, elbow arthroscopy allows faster recovery, because the pain is less intense compared to open surgery. The goal is to start early rehabilitation to prevent stiffness and muscle atrophy.

(On the website you can find general guidance: it is in any case necessary to strictly follow the prescription of the surgeon and physiotherapist treating you.)

 



Bibliography  

1. Burman MS. Arthroscopy or the direct visualization of joints. J. Bone Joint Surg 1931; 4: 669-95 

2. Casscells SW. Neurovascular anatomy and elbow arthroscopy: inherent risks - Editor's comments. Arthroscopy 1987; 2: 190. 

3. G. Lynch, Meyers J, T Whipple, Caspari R. Neurovascular anatomy and elbow arthroscopy: inherent risks. Arthrocopy 1986 2: 191. 

4. Thomas M, Fast A, Shapiro D. Radial nerve damage as a complication of elbow arthroscopy. Clin Orthop. 1987, 215, 130-131 

5. O'Driscoll SW, Morrey BF Arthroscopy of the elbow. Diagnostic and therapeutic benefits and hazards. J Bone Joint Surg. 1992, 74A: 84-94 

6. Steinmann SP Elbow arthroscopy. Journal of American Society of the hand. Vol.3, No.4, Nov.2003, 199-207 

7. Kelberine F. Arthroscopy of the elbow. Journal of the einseignement SOFCOT. Conferences einseignements 2003 pag.55-68. 

8. Morrey B F. Arthroscopy of the elbow. Instructional Course Lec. 35: 102-107, 1986. 

9. O'Driscoll SW, Morrey BF. "Arthroscopy of the elbow." The elbow and its disorders. Morrey BF ed. 1993 W. B. Saunders Company. Philadelphia: 120-130. 

10. O'Driscoll SW, Morrey BF. "Arthroscopy of the elbow." Master techniques in orthopedic surgery: The elbow. Morrey BF ed. 1994 Raven Press.New York: 21-34. 

11. Boe S. Arthroscopy of the elbow. Diagnosis and extraction of loose bodies. Acta Orthop Scand. 57: 52-53, 1986. 

12. J. McGinty Arthroscopic removal of loose bodies. Orthop Clin N Amer. 13: 313-328, 1982. 

13. O'Driscoll SW Elbow arthroscopy: loose bodies. " The Elbow and Its Disorders. Morrey B ed. 2000 W. B. Saunders Company. Philadelphia: 510-514. 

14. O'Driscoll SW. Elbow arthroscopy for loose bodies. Orthopedics. 15: 855-859, 1992. 

15. Ogilvie-Harris DJ, Schemitsch E. Arthroscopy of the elbow for removal of loose bodies. Arthroscopy. 9: 5-8, 1993. 

16. SW O'Driscoll Arthroscopy of the elbow. Orthopedic mastery. 2003 No. 110. 

17. Locker B. Treatment of extraneous intra-articular elbow. Arthroscopy. French Society of Arthroscopy, Ed Blackwell, 411-413,1999. 

18. JP Bonvarlet Directions exceptional elbow arthroscopy. Arthroscopy. French Society of Arthroscopy, Ed Blackwell, 417-418,1999. 

19. Bonvarlet JP Arthroscopic treatment of osteochondritis dissecans of the elbow. Arthroscopy. French Society of Arthroscopy, Ed Blackwell, 417-418,1999. 

20. B. F. Morrey B. F. Ulnohuméral arthroplasty. Master Techniques in Orthopedic Surgery. THE ELBOW. 2002 Pg. 369-380 

21. Gallay SH, Richards RR, O'Driscoll SW. Intraarticular capacity and compliance of stiff and normal elbows. Arthroscopy 1993; 9: 9-13. 

22. Feldman MD Arthroscopic excision of type II fractures capitellar. Arthroscopy 1997; 13: 743-8. 

23. Grifka J, Boenke S, Kramer J. Endoscopic therapy in epicondylitis radialis humeri. Arthroscopy. 11: 743-8., 1995. 

24. Kerr D. Prepatellar and olecranon arthroscopic bursectomy. Clin Sports Med 1993; 12: 137-42) 

25. Mansat P Lille R. Elbow Arthroscopy: Indications and techniques. Surgical pathology of the elbow. Sauramps Medical. 1999, 63-75. 

26. Guhl J. Arthroscopy and arthroscopic surgery of the elbow. Orthopedics. 8: 1290-1296, 1985. 

27. Lynch G, Meyers J, T Whipple, Caspari R. Neurovascular anatomy and elbow arthroscopy: Inherent risks. Arthroscopy. 2: 191-197, 1986. 

28. Ward WG, Anderson TE. Elbow arthroscopy in a mostly athletic population. J Hand Surg. 18A: 220-224, 1993. 

29. Schneider T, Hoffstetter I, Fink B, Jerosh J. Long-term results of elbow arthroscopy in 67 patients. Acta Orthop Belg. 60: 378-383, 1994.
< Prev
Last Updated on Tuesday, 11 January 2011 10:55