Elbow Anatomy
The elbow is a complex joint formed by the joining of three bones:
The humerus (upper arm bone)
The ulna (forearm bone on the pinky finger side)
The radius (forearm bone on the thumb side)
The surfaces of the bones where they meet to form the elbow joint are covered with articular cartilage, a smooth substance that protects the bones and acts as a natural cushion to absorb forces across the joint. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the elbow joint. In a healthy elbow, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction as you bend and rotate your arm.
On the inner and outer sides of the elbow, thicker ligaments (collateral ligaments) hold the elbow joint together and prevent dislocation. The elbow joint is surrounded by muscles on the front and back sides. In addition, the three major nerves that cross the elbow joint are located close to the joint surfaces and capsule and must be protected during arthroscopic surgery.
The elbow joint allows two basic movements: bending and straightening (flexion and extension) and forearm rotation (pronation — palm down, and supination — palm up).
Normal bending and straightening motion occurs at the joining of the humerus and ulna bones. Forearm rotation occurs at the joining of the ulna and radius and is also influenced by muscles and ligaments further down the forearm and at the wrist joint.
At Aptiva Health, we offer same-day and walk-in appointments for elbow injuries and conditions to evaluate, diagnose, and make the appropriate referral for additional treatment based upon your specific elbow injury or condition. We treat these conditions in our General Medicine, Orthopedics, Sports Medicine, and Physical Therapy departments.
Conditions Treated by Elbow Arthroscopy
Common arthroscopic procedures include:
Removal of loose bodies (loose cartilage and bone fragments)
Release of scar tissue to improve range of motion
Treatment of osteochondritis dissecans (activity related damage to the capitellum portion of the humerus seen in throwers or gymnasts)
Description of Procedure
If elbow surgery has been recommended by Dr. Ryan Eads, he will have explained the procedure completely in the office before scheduling. On the day of the operation, you will be evaluated by a member of the anesthesia team. Elbow arthroscopy is usually performed using general anesthesia (you are put to sleep). Regional nerve block injections (you are awake but the elbow area is numb) are rarely used in elbow arthroscopy because the numbing effect can continue for hours after surgery is finished. Although this can help with pain management, it prevents your surgeon from performing a careful nerve examination in the recovery room to be sure that the nerves traveling down your arm are functioning properly. Your surgeon will see you before the surgery and sign your elbow to verify the surgical site.
In the operating room, you will receive general anesthesia and possibly intravenous antibiotics to lessen the risk of infection after surgery. Your surgeon may draw lines on your elbow to indicate specific structures (such as the ulnar nerve and olecranon bone), incision placements and portals for the arthroscope.
During surgery, your surgeon will make several small incisions to introduce the arthroscope and other small instruments. Filling your elbow with fluid will allow a clearer view inside the joint, and lessen risk of injury to surrounding blood vessels and nerves. Your surgeon will review projected images from the arthroscope to evaluate the inside of your joint before any specific treatments are begun. Once the problem is identified, your surgeon will insert specialized instruments for tasks such as shaving, cutting, grasping, suture passing and knot tying, as well as a special device often used to anchor stitches into bone. Incisions may be stitched or covered with skin tapes, followed by application of an absorbent dressing. Depending on the procedure, your surgeon will then apply an additional soft dressing that allows movement, or a plaster splint that restricts movement and offers more protection.
You will remain in the recovery room for 1 or 2 hours after surgery. During that time, nurses will monitor your responsiveness and recovery from the anesthesia, and provide pain medication, if needed. You may be given a regional anesthetic for pain control—after your orthopedic surgeon has completed a nerve examination. When you are ready to go home, you will be given discharge instructions covering medications, need for ice and elevation, and dressing care. You will need someone to drive you home and stay with you, at least during the first night.
Recovery
Although recovery from arthroscopy is often faster than recovery from open surgery, your elbow joint may need weeks to recover completely. You can expect some pain and discomfort for at least 2 weeks after surgery. If your surgery was extensive, it may be several weeks before the pain subsides. Your doctor will likely prescribe pain medicine to be taken regularly for the first few days after surgery, as well as other medications such as stool softeners or anti-inflammatory drugs.
It is important to apply ice and elevate your elbow regularly for 48 hours after surgery to reduce the risk of severe swelling and to help relieve pain. To elevate, place your elbow in a resting position that is higher than your heart, with your hand placed higher than the elbow. Depending on the type of surgery performed, your doctor may give you specific instructions for longer periods of ice and elevation.
You will probably be encouraged to move your fingers and wrist frequently to help stimulate circulation and minimize swelling. Early range-of-motion exercises may also be recommended to prevent joint stiffness. Your orthopaedic surgeon will let you know when you can begin these gentle exercises and return to daily activities.
Dressing care will depend on the type of surgery performed and the preferences of your physician. In most cases, the operative dressing and/or splint is removed 2 to 3 days after surgery. During this time, your dressing must be left intact and kept dry. In some instances, you may be instructed to keep the dressing in place until your first postoperative clinic visit.
Rehabilitation
Rehabilitation plays an important role in getting you back to your daily activities. Your surgeon will develop an exercise program to help you facilitate motion, strength, and return of function of the elbow. This may include basic exercises to begin at home, or for more advanced surgeries, physical therapy may be prescribed after the first postoperative visit. The physical therapy prescribed will depend on the type and severity of your problem and the surgery required. Your surgeon will tell you when you can return to work, driving and normal daily activities.
Complications
Although most patients experience no complications after elbow arthroscopy, as with any surgery, there are some risks. These are typically minor, treatable and unlikely to affect your final outcome. Potential problems include infection, excessive bleeding, blood clots, and damage to blood vessels or nerves. Most studies report a slightly higher risk of infection and nerve irritation/injury following elbow arthroscopy as compared to arthroscopy of the shoulder and knee joints. Discuss the potential risks and benefits with your orthopaedic surgeon prior to surgery.
Outcomes
The time needed for complete recovery varies according to the patient, the condition of the joint, and the extent of damage and repairs required. If your repair was minor, you may not need a splint, your range of motion and function may return after a short period of rehabilitation, and you may be able to return to work or school within a few days of the surgery. More complicated procedures may require as long as several months for a full recovery. Although the process may seem slow, following your surgeon's guidelines and rehabilitation plan is vital to a successful outcome.