Elbow Surgery - Joint Pain, Treatment & Surgery
By Dr. Stuart Gold, M.D., Orthopedic Surgeon & Author
The elbow is a hinge joint located between the shoulder and the wrist. Three bones - the upper arm, known as the humerus and the forearm bones, known as the ulna and radius - comprise the elbow. The joint, in turn, has three distinct portions, the proximal radioulnar, the humeroulnar, and the humeroradial. When a patient experiences problems with the elbow, all three regions are typically evaluated together to determine the nature of the problem and the appropriate treatment option. Multiple ligaments and tendons are also an integral part of the elbow. Injuries to any of these parts can be from a specific injury or from overuse.
Elbow function involves not only straightening or bending the arm but, in conjunction with the wrist, the ability to twist the forearm as well. This action is referred to as pronation and supination. While the normal, relaxed position of the arm allows the ulna and the radius to remain parallel to one another, during pronation and supination, the radius rolls around the ulna at the elbow and wrist. The majority of the stress occurs between the radius and the humerus at the elbow.
Often, the pain that occurs during normal elbow operation, such as opening a jar or straightening the arm, is due to overuse or injury of the surrounding tendons and ligaments rather than the bones. The pain can be on either side of the elbow, depending on what activity caused the problem. Elbow surgery is seldom needed to correct "tennis elbow" or ‘golfer’s elbow”. However, when required, repairs can normally be made using a minimally invasive technique. Recovery times have been greatly reduced during the last two decades for this type of surgery.
Another common soft tissue problem around the elbow is entrapment of the ulnar nerve in the cubbital tunnel. This is referred to as cubbital tunnel syndrome. Similar to carpal tunnel syndrome, which is entrapment of the median nerve at the wrist, cubbital tunnel syndrome symptoms are neurogenic pain from poor conduction of the nerve impulses. This delay of nerve transmission affects the strength and sensation primarily in the hand. If the nerve is damaged and the hand function is diminished surgical release of the nerve may be indicated.
Elbow Surgery - When Is It Needed?
Most elbow surgery is needed due to injuries or arthritis. Any or all of the three bones comprising the elbow can be fractured. Fractures and dislocations account for about 20 percent of all elbow injuries, since it is among the most frequently dislocated in the human body. Both rheumatoid arthritis and osteoarthritis can also necessitate the need for elbow surgery.
Elbow surgery is normally considered only when other treatment options have been unsuccessful. Physical therapy, NSAIDs, braces, and changes to activities are typically the first line of treatments. If, however, the pain is severe, does not respond to pain relievers or anti-inflammatory medications, or interferes with the patient's ability to sleep at night, surgery may be considered the most viable option. Decreased mobility or unnatural elbow operation can also indicate a need for a surgical solution. Normally, the least invasive method of elbow surgery will be attempted first.
For patients with rheumatoid arthritis, a synovectomy may be recommended. Typically an arthroscopic procedure, this operation removes the inflamed or swollen synovial tissue that surrounds the elbow. This tissue is normally the cause of the elbow pain and may be all that is necessary to give relief. Osteoarthritis sufferers may also benefit from an arthroscopic procedure known as debridement. In this procedure, bone spurs, loose cartilage, or bone chips are removed. A relatively new procedure to assist patients with arthritis is osteocapsular arthroplasty. This combines a synovectomy and extensive debridement with a procedure to re-contour deformed or degenerated bones. As a recently introduced procedure, osteocapsular arthroplasty may not be available in all areas.
Types Of Elbow Surgery
Interposition arthroplasty is a procedure performed on those who may not be candidates for elbow replacement. With this surgery, the orthopedist resurfaces the elbow joint. This can reduce pain by eliminating the rubbing of one against another during normal elbow operation. In cases where the pain is largely confined to movement, the procedure may be all that is required to effect a cure.
When normal elbow operation cannot be restored by other methods, elbow replacement surgery may be recommended. A partial elbow replacement involves resurfacing the area where the humerus and radius meet. If there has been a previous fracture, the capitellum joint may also be resurfaced. Total elbow replacement is normally the last option considered. This procedure involves the removal of the elbow and the placement of a prosthetic joint.
Elbow surgery typically has a high success rate. Post-operative physical therapy may be needed to ensure complete elbow operation restoration. In some cases, patients may need to utilize a sling or brace for a short time while healing occurs.