Advances in arthroscopy over the years make it a valuable tool in both the diagnosis and treatment of many elbow disorders. Arthroscopic surgery of the elbow requires special skill because of the anatomy of the elbow joint. The bones lie close together and the nerves and blood vessels are located very close to the joint.
While very useful in the evaluation of patients with chronic elbow pain, elbow arthroscopy is also instrumental in the removal of osteophytes as a result of impingement or osteoarthritis, as well as adhesions and capsular release in patients with contractures. It is used in the removal of loose bodies and for synovectomy of patients suffering from inflammatory arthritis.
Loose Body Removal
Elbow arthroscopy in the removal of loose bodies resulting from a fracture or degenerative condition is frequently used and yields a 90 percent or better success rate. The loose bodies are removed with various sized graspers with "teeth," and the assistance of the sheath of the arthroscope.
The capsular release of the joint capsule of the synovial membrane (removal of excessive synovial fluid causing the synovial membrane to become inflamed) is generally required to restore motion and eliminate pain during motion in those suffering from rheumatoid arthritis. During a synovectomy (surgical removal of the joint lining that has become inflamed), careful attention is paid to the radial and ulnar nerves, which lie very near the capsule. During this procedure, any visible scar tissue from previous joint damage is removed - as are osteophytes (bone spurs) that may be present.
A capsular release is performed after a synovectomy has failed to restore sufficient motion. Once all synovium is cleared from the joint capsule and the nerves are arthroscopically visualized and determined to be a safe distance from the cutter, the soft tissue behind the capsule is dissected away in order to create a safe plane for incision of the capsule. The capsule is then removed in stages.
Recovery and Rehabilitation
Following elbow arthroscopy, a compressive dressing is wrapped around the elbow and movement is encouraged as tolerated. Initially the elbow is elevated when not in use, in order to reduce swelling, and a catheter may be inserted for brachial plexus block anesthetic, in order to begin range of motion exercises.
Recovery following arthroscopic treatment of an elbow injury or condition is generally more rapid than after traditional open surgery.