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Elbow Synovectomy

What Is It?

Elbow synovectomy surgery is done to remove inflamed joint tissue (synovium) that is causing unacceptable pain or is limiting ability to function or range of motion. Ligaments and other structures may be moved aside to access and remove the inflamed joint lining. The procedure may be done using arthroscopy.

Anatomy

A joint is where the ends of two or more bones meet—such as an elbow, knee, shoulder, or ankle. Thick bands of tissue surround the joint, forming a capsule that holds it together. The undersurface of the joint capsule is lined by a thin membrane called the synovium. The synovium produces a fluid that lubricates the joint.

The synovial fluid nourishes loose bodies that they may grow, calcify (harden), or ossify (turn into bone). When this occurs, they can roll around freely inside the joint space. As the move around, they can damage the cartilage that covers the joint.

Indications for Synovectomy

The condition most often occurs in patients between the ages of 30 and 50. Men are affected twice as often as women. The condition occurs spontaneously and is not inherited. 

Medical history and examination of the joint for warmth, tenderness to the touch, swelling, or thickening of the joint that feels “spongy” will determine if an MRI or other imaging is needed.

Symptoms include:
  • Joint pain
  • Joint swelling
  • Limited range of motion in the affected joint
  • Fluid in the joint
  • Tenderness
  • A creaking, grinding, or popping noise during movement (crepitus)
  • The nodules can sometimes be felt in joints that are close to the skin
Procedure

Elbow synovectomy surgery may be performed either as an open surgical procedure or with the aid of arthroscopy, in which the surgeon uses miniaturized instruments, fiberoptic technology, and a tiny camera inserted through very small incisions in the skin. Magnified pictures from the camera are projected onto a television monitor which guides the surgeon throughout the procedure. The surgery primarily involves the removal of inflamed synovium. Surgery may also include elbow debridement which consists of smoothing rough, fibrillated articular structures as well as the removal of damaged tissues, bone and loose bodies that interfere with the motion of the joint.

The technique will depend upon:
  • The number of loose bodies
  • The size of the loose bodies
  • The condition of the synovium
  • Illustration of traditional open procedure to remove loose bodies
The end results of both open and arthroscopic procedures are the same. Elbow synovectomy surgery can yield dramatic improvement in function and pain relief. Left untreated, the more synovitis could develop, which can eventually lead to complete destruction of articular cartilage and the need for joint replacement surgery.

Postoperative Care and Recovery

How long it takes to return to daily activities will vary, depending on the type of procedure. Specific instructions to guide rehabilitation.

The condition may return in up to 20 percent of patients. Follow-up visits are needed to check for any recurrence. The joint should be monitored for any progression of osteoarthritis. Physical therapy is required for the return of full function.

Risks and Complications

As with all surgery, risks and complications can occur. The possible complications following synovectomy include: infection, bleeding, nerve and blood vessel damage, damage to bone surface, and no relief of symptoms. Synovium can grow back and may require repeat surgery.