Elbow Arthroscopy – Stiff Elbow, Cause and Treatment – New Delhi, India

Elbow Arthroscopy Stiff Elbow, Cause and Treatment New Delhi

, India

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 theligamentalong the inner aspect of the elbow (medialcollateralligament.) 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 thearthroscopic 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.

An elbowarthroscopy introduces anarthroscope (small 'telescope') into the elbow joint through several small 2-3 millimeter incisions.

Thearthroscope is used to identify the location of the loose bodies and the spurs.

The loose bodies can be removed by using thearthroscope in addition to small grasping instruments. The bone spurs can be removed by visualizing the spur with thearthroscope and using a small burr to remove the spur.

These elbowarthroscopic procedures take about 30-90 minutes and are done on an day-case basis (without an overnight stay in the hospital).

The elbow joint is a type of hinge joint. It bends (flexion) and straightens (extension), as well as rotating to position your palm up or down. The normal range of flexion and extension is from 0 to 145 degrees, although the range of motion that we work within for daily activities is only from 30 to 130 degrees. This means that for most people a bit of loss of motion does not cause problems with function. However, with a reduction of extension greater than 30 degrees and or a flexion less than 130 degrees most people will complain of loss of function. Loss of extension is usually less disabling than loss of same degree of flexion.

Factors that cause stiffness are divided into those that are within the elbow joint itself (intrinsic) and those in the tissues around the joint, such as the muscles andtendons(extrinsic).

Intrinsic / Intra-articular Causes

Post-traumatic Osteoarthritis

Primary Osteoarthritis

Rheumatoid

Joint Infection

Malunions

Extrinsic / Extra-articular Causes

Burns

Heterotopic Ossification

Congenital arthrogryposis, congenital disloc radial head

Treatment

The aim is to give the patient pain-free, functional and stable elbow. This means 30-130 degrees flexion and 100 degrees of rotation.

Physiotherapy involves passive motion exercises and stretching (not too aggressive) and active exercises. Ideally this should be with a physiotherapist who has an interest in upper limb rehabilitation.

Splinting may be used and is well tolerated and is effective when performed in a static progressive fashion.

Surgery is indicated when patients are no longer improving in their original posttraumatic rehabilitation program. At least 3 to 6 months should be allowed for the inflammatory phase of soft tissue healing to resolve.

This may be performed via keyhole (arthroscopy) or open surgery. The decision depends on the surgeon's experience and the type of stiffness.

arthroscopic release is ideal for stiffness due to arthritis and when there has been no previous surgery. However, if there has been a previous internal fixation and there are extrinsic causes for the stiffness open surgery is required.

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