April 7th, 2011
The other day a patient asked me, “Are there different types of elbow surgery?” To help her (and perhaps you), I put together the information below.
The elbow is an important joint and is subject to extensive use during daily activities. Because it often has to bear a great deal of overuse, there are many things that can go wrong with the elbow. Doctors have developed numerous procedures to deal with the problems that can arise in and around the joint.
The biggest type of elbow surgery that orthopedic surgeons typically perform on the elbow is a total elbow replacement (TER). When medical treatment has been exhausted for advanced elbow arthritis or in the elderly with very complex fractures, a TER should be considered after the patient has been given anesthesia, a tourniquet is applied on the upper arm to reduce the blood flow. An incision, normally about six inches in length, is made to expose the bones. The elbow joint is removed and the bones prepared for the prosthetic. Metal stems are inserted into the center of the bones, into which cement has been injected. After the cement hardens, the two stems are connected with a pin.
If the patient is not a candidate for a joint replacement, or if movement causes the pain in the elbow, the surgeon may perform an interposition arthroplasty. This procedure involves placing either a portion of the patient’s soft tissue or an artificial tissue between the ends of the bones that comprise the elbow joint. This usually eliminates the abrasive action of bone on bone and can provide pain relief.
A synovectomy is often recommended for those with rheumatoid arthritis or other forms of inflammatory arthritis when nonoperative treatments have failed. This procedure can be performed arthroscopically or open in order to remove the synovial tissue surrounding the elbow that has become swollen and inflamed. The inflamed synovial tissue is a frequent cause of elbow pain among rheumatoid arthritis patients, and the procedure may alleviate the pain.
A debridement is an arthroscopic procedure to remove bone chips, damaged cartilage, or bone spurs, all of which can occur in patients with osteoarthritis. An osteocapsular arthroplasty is a combination of debridement and synovectomy. This procedure is also used frequently for arthritic elbows, and may involve re-contouring the ends of bones that have degenerated or become deformed.
Surgery for tennis elbow is seldom recommended unless the patient is experiencing pain that is incapacitating and that does not improve after six to twelve months of treatment. The procedure is normally performed on an outpatient basis using a local anesthesia. The surgeon normally makes a small incision through which he can remove the damaged portion of the tendon and reattach the healthy tissue to the bone.
Elbow surgery is also performed if a nerve is being compressed, limiting function and causing pain. Surgery for an ulnar nerve entrapment is normally performed in the area around the elbow. Techniques vary, but the most common involves moving the nerve from the back to the front of the joint. This technique is known as an anterior transposition. The nerve can be repositioned beneath muscle tissue in a submuscular transposition, inside the muscle in an intermuscular transposition, or on top of the muscle but beneath the skin in a subcutaneous transposition. The procedure is normally performed as outpatient surgery, but in some instances, it may involve one-day hospitalization.
Another common procedure, particularly among athletes, is to repair a biceps tendon tear. This surgery is normally performed no later than two weeks after the injury, since a longer delay can leave the tendon scarred and impossible to return to its normal position. Various techniques are used, including implanting devices to which the surgeon can tie the tendon or drilling into the bone to anchor sutures. Recovering from surgery to repair a ruptured tendon can be lengthy. Physical therapy is often required, but patients are typically advised to avoid pulling, lifting, or overtaxing the arm for many months.
Until next time,
|About the Author: Dr. Stuart Gold, M.D. is a board certified orthopedic surgeon who has 23 years experience specializing in sport injuries, joint replacement, arthritis and limb salvage. As the Director of the Orthopedic Institute, Dr. Gold recently published The Patient's Guide To Orthopedic Surgery to help patients better understand the challenges, risks and opportunities of orthopedic care.|