Elbow arthroscopy is a minimally invasive technique used by orthopedic surgeons to diagnose and treat a range of conditions affecting the joint. As in other joints, arthroscopy of the elbow involves the use of fiberoptics and a tiny camera lens that is inserted through small incisions or portals. Magnified pictures from the camera are projected onto a television monitor in the operating suite. When the procedure is employed to treat an injured or diseased joint, the orthopedic surgeon inserts miniaturized surgical instruments through an additional portal. In contrast to traditional surgery, using large incisions to open the joint, there is no injury to surrounding soft tissues with arthroscopy. Moreover, the technique allows the surgeon to view the elbow joint from multiple angles, allowing for a more thorough evaluation.
One of the more common elbow injuries is ulnar nerve impingement, or cubital tunnel syndrome. The ulnar nerve is a nerve that passes around the elbow, leaving it exposed. If you have ever banged your elbow and struck your “funny bone,” then you have hit the ulnar nerve. In cases where the ulnar nerve is chronically inflamed or entrapped, surgery may be required. The surgery relocates the ulnar nerve from its exposed position to a more protected location. This surgery is done in a traditional, “open” manner.
Epicondylitis “Tennis Elbow”
Another common elbow problem is lateral epicondylitis, more commonly known as tennis elbow. Tennis elbow can be caused by overuse or trauma to the fibers that attach the muscles extending from the outside of the elbow to the wrist and fingers, causing the fibers to inflame. While most cases of tennis elbow resolve through conservative treatment, some cases require surgical treatment. The most common surgical treatment of lateral epincondylitis is a simple excision of the diseased tissue from within the tendon, shaving down the bone and reattaching the tendon. Most times, this surgery is also done in a traditional, “open” manner and is very effective, with over 85% of patients returning to pain-free normal activity after 2-3 months of recovery.
Arthroscopic verses Open Surgery
While the use of arthroscopy in the elbow is gaining popularity, many surgeons prefer traditional, open approaches to treating elbow problems. The reason is because the elbow is a more complicated joint than most. The location of nerves and vessels also make arthroscopic elbow surgery a challenge. Nonetheless, many surgeons are finding arthroscopy useful for removal of loose bodies, treatment of arthritis and chondramalacia, olecrenon impingement and release of tennis elbow.
Before performing an elbow arthroscopy, the orthopaedic surgeon may obtain an MRI (magnetic resonance imaging) and X-rays of the joint.Respectively, these images provide information about the soft tissues surrounding the bones—cartilage, tendons and ligaments—and the bones themselves which may have irregularities including spurs (extra growths that can cause pain and inflammation). Placement of the portals may also be guided by these findings.
Elbow arthroscopy is used as a diagnostic tool for pain, stiffness, and loss of motion in the joint. Some of the more common diagnoses include:
– Adhesions, soft tissue bands that block motion as a result of a previous injury to the elbow, such as a fracture
– Contractures, a condition in which the muscle and tendons are abnormally contracted, thereby limiting range of motion
– Loose bodies, fragments of bone or cartilage that break loose causing pain, catching and locking of the joint, and
– Arthritis, a disease that is characterized by the wearing away of cartilage, the tissue that helps bones glide smoothly against each other during movement.
The orthopedic surgeon can also treat certain conditions using arthroscopy, arthritic bone can be debrided—a technique that renders the surfaces that come in contact with one another smoother and less likely to cause stiffness and catching during movement. Loose bodies can be removed and adhesions and contractures released, thereby improving or restoring range of motion. And, arthroscopy is used by some orthopedic surgeons to debride or cut away the unhealthy portion of the tendon in tennis elbow.
Ulnar Collateral ligament injury
Elbow arthroscopy is a very useful technique for diagnosis and treatment of problems in the subgroup of patients made up of throwing athletes, especially baseball pitchers. In this population elbow arthroscopy is used to confirm injury of the ulnar collateral ligament and to treat spurs and cartilage injuries that occur—particularly in the posterior aspect of the elbow.
Constraints of Elbow Arthroscopy
Although elbow arthroscopy was developed more than a decade ago, it remains less commonly used than arthroscopy of other joints such as the knee or shoulder. The constraints of working in the elbow, a very tight space in which the nerves pass closely over the joint, require specialized training. Proximity of those nerves also constitutes the major risk specific to the procedure, nerve injury that can result in temporary numbness.
Elbow arthroscopy is performed under regional or local anesthesia.