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Elbow Arthroscopic Debridement

What Is It?

Elbow arthroscopy is a minimally invasive procedure to inspect, diagnose and repair problems inside the elbow joint. Debridement is a procedure for treating a wound. It involves thoroughly cleaning the wound and removing all hyperkeratotic (thickened skin or callus), infected, and nonviable (necrotic or dead) tissue, foreign debris, and residual material.

Anatomy

The elbow is made up of the humerus (upper arm bone), the ulna (the large forearm bone) and the radius (the small forearm bone). Two main ligaments—the ulnar collateral ligament and the lateral collateral ligament—hold the bones of the elbow together. Muscles and tendons support the joint and allow the bending and straightening of the arm.

Indications for Elbow Arthroscopy

Elbow arthroscopy may be recommended if a painful condition does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation. Injury, overuse, and age-related wear and tear are responsible for most elbow problems. Elbow arthroscopy may relieve painful symptoms of many problems that damage the cartilage surfaces and other soft tissues surrounding the joint. It may also be recommended to remove loose pieces of bone and cartilage, or release scar tissue that is blocking motion.

Common arthroscopic procedures include:
  • Treatment of tennis elbow (lateral epicondylitis)
  • Removal of loose bodies (loose cartilage and bone fragments)
  • Release of scar tissue to improve range of motion
  • Treatment of osteoarthritis (wear and tear arthritis)
  • Treatment of rheumatoid arthritis (inflammatory arthritis)
  • Treatment of osteochondritis dissecans (activity related damage to the capitellum portion of the humerus seen in throwers or gymnasts)
Procedure

During this outpatient procedure, the surgeon examines the inside of the elbow joint with a camera called an arthroscope. They then identify and correct problems with the bones, ligaments and tendons of the elbow.

Because the arthroscope and surgical instruments are thin, surgeons can use very small incisions, rather than the larger incision needed for open surgery. This results in less pain for patients, less joint stiffness, and often shortens the time it takes to recover and return to favorite activities.

Postoperative Care and Recovery

Although recovery from arthroscopy is often faster than recovery from open surgery, it may still take weeks for an elbow joint to completely recover.

It is typically recommended to ice and elevate an elbow regularly for 48 hours after surgery. This will reduce the risk of severe swelling and help to relieve pain. Depending on the type of surgery performed, the doctor may have specific instructions for longer periods of ice and elevation. Pain medication may also be recommended. Dressing care is contingent on the type of surgery performed.

Patients typically begin physical therapy soon after surgery to stretch and restore strength and range of motion. Most return to light work within several days. If heavy lifting or throwing is required a patient may be out for several weeks. Full recovery and return to pre-injury athletic activities occur within three to six weeks for loose body removal and two to three months for elbow spur removal.

Advantages

The advantages of arthroscopy compared to open surgery with a large incision include:
  • Less pain
  • Fewer complications
  • Shorter hospital stays
  • Faster recovery
Risks and complications

Complications of elbow arthroscopy include infection, bleeding, damage to nearby nerves or blood vessels, or delayed healing after the surgery. In certain cases, a stiffness of the elbow joint may occur after the surgery. It is important to participate actively in physical therapy to prevent this from occurring.

Source: https://orthoinfo.aaos.org/