Everything You Should Know about Orthopedic Elbow Surgery

Human elbow is a relatively simple hinge joint which allows extension and flexion. Although simple, the elbow is one of the most regularly used joints in the body. That’s why it’s prone to injuries, as a contact point for trauma and repetitive stress injuries. Most conditions affecting the elbow are successfully treated through conservative therapies that include medications and physical therapy. According to a study published in the journal Archives of Bone and Joint Surgery, elbow surgeries are quite uncommon which is why it’s difficult to determine the most frequently performed procedures in the US. However, in cases when traditional treatments don’t help or due to severe injuries, elbow surgery poses as the best solution. The purpose of this article is to highlight different procedures and their purposes.

Orthopedic Elbow Surgery

Elbow joint anatomy (Photo credit: commons.wikimedia.org)

Tennis elbow surgery

Tennis elbow is a painful condition caused by overuse of the arm, forearm, and hand muscles. Although it’s called a tennis elbow, a person doesn’t necessarily have to play tennis to contract this condition. It is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. Between 80% and 95% of patients have success with nonsurgical treatments that include rest, physical therapy, medications, and brace, as well as steroid injections.

However, if symptoms don’t reduce in after 6 to 12 months, the doctor may recommend surgery. Surgical procedures of the tennis elbow include removal of diseased muscle and reattaching the healthy muscle back to the bone. The choice of procedure depends on multiple factors such as:

  • Patient’s general health
  • Severity of condition
  • Personal needs

 

Procedures used to address tennis elbow are:

  • Open surgery – the most common surgery for tennis elbow. Here, the doctor makes an incision over the elbow, and it’s performed in the outpatient setting
  • Arthroscopic surgery – involves using miniature instruments and making small incisions. It rarely requires overnight stay

Regardless of the surgical procedure, the patient’s arm may be temporarily immobilized with a splint which is removed one week later. When the splint is removed, the patient has to undergo physical therapy to restore flexibility in the elbow. Returning to athletic activities depends on the speed of the recovery process, in most patients, it’s four to six months after surgery.

Elbow bursitis surgery

Elbow bursitis is an inflammation of small sacs of fluid or bursae that help joints move easily. The condition can occur due to a variety of reasons such as trauma, infection, or prolonged pressure and it’s indicated by swelling and pain. Surgery of elbow bursitis isn’t frequently recommended mostly because other treatments prove to be successful. In cases when pain and swelling don’t respond to treatments within three or four weeks, the doctor may recommend addressing the problem through surgery.

Surgical procedure for non-infected bursa is performed in an outpatient setting. The procedure doesn’t disturb any ligament, muscle, or joint structure. On the other hand, surgery for infected bursa usually includes removal of the entire bursa and it’s performed in the inpatient setting. The bursa grows back as fully functioning and non-inflamed bursa that doesn’t cause pain and swelling, within a few months. Surgical removal of bursa is an option when bursitis limits a patient’s activity.

In cases when infected bursas prove to be slow to health, the surgical drainage poses as an adequate solution. During the procedure, the surgeon makes an incision to open the bursa, and keeps skin and bursa open by inserting a drain tube into the affected sac for several days thus allowing pus to drain.

Total elbow replacement

The elbow joint replacement isn’t as common as knee or hip replacement, but it’s equally successful in relieving joint pain and allowing patients to return to their everyday activities. Elbow replacement is mostly performed in patients with rheumatoid arthritis, osteoarthritis, or in cases when severe injuries damaged the elbow.

During the procedure, the surgeon replaces damaged parts of the ulna and humerus with artificial components usually made of metal and plastic hinge with two metal stems. The surgeon makes an incision at the back of the elbow to reach the joint and gently move muscles aside to access the bone easily. After removing spurs and scar tissue around the joint, the surgeon starts making necessary “arrangements” to place the implant in the ulna and humerus bones. The entire procedure usually lasts up to two hours and a patient spends about four days in the hospital.

After the surgery, the patient is instructed now to lift anything with the operated arm for about six weeks.

Elbow arthroscopy

The procedure was briefly mentioned as one approach to surgically address tennis elbow. Arthroscopy is a procedure that surgeon uses to inspect, diagnose, and repair problems inside a joint. Besides tennis elbow, the procedure is also necessary for:

  • Damage caused by osteoarthritis
  • Removal of loose bodies
  • Damage caused by rheumatoid arthritis
  • Release of scar tissue

The procedure requires general anesthesia, meaning the patient is put to sleep. During the operation, the surgeon fills the elbow joint with fluid which helps him/her see the structures of elbow more clearly. Then, several small incisions are made to introduce small instruments and arthroscope to the joint. In most cases, the patient can go home the same day. Although the recovery process is much faster than in open surgery, it will still take a few weeks for the elbow to recover entirely.

There are various types of arthroscopic procedures, and their choice depends on the condition or severity of the injury. For example:

  • Arthroscopic synovectomy – elbow surgery option for individuals affected by arthritis. It includes removal of the synovium (the soft membrane lining of the joint). Recovery time depends on how the procedure was performed. In most cases, rehabilitation takes at least two months.
  • Arthroscopic debridement – the procedure to remove the bony growths in the joint along with loose bits of cartilage or bone. Recovery time after the procedure is between 12 and 14 weeks.

Conclusion

Elbow surgeries aren’t quite common mostly because traditional treatments manage to treat the condition affecting the elbow promptly. In cases when surgery is necessary, the doctor evaluates overall condition, general health, and personal needs of the patient to determine the adequate approach. Generally, arthroscopic procedures have a shorter recovery time.

References

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322118/
http://orthoinfo.aaos.org/topic.cfm?topic=A00068
http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/elbow/olecranon-bursitis/
http://www.webmd.com/rheumatoid-arthritis/elbow-replacement-surgery