Surgical Conditions Affecting the Elbow suitable for Arthroscopic Surgery

1. Loose bodies
2. Capsular contracture
3. Synovitis
4. Tennis/golfer's elbow
5. Arthritis

Loose Bodies

Small pieces of bone or cartilage may break off the joint surfaces or grow in folds of the joint lining (synovium). These loose bodies can then move around inside the joint and on occasions get caught between the major bones (humerus, ulna & radius).

Patient experience:

1. episodes of locking, often can be unlocked by flexing or twisting the elbow
2. sharp pains with movements of elbow
3. occasionally, loss of full movement of the joint, especially if present for a long time
4. often swelling from fluid in the joint due to irritation of the joint lining

Investigation with Xrays may not show the loose body as the joint is complex in a 3 dimensional aspect and difficult to show on a 2 D film. A CATScan may be more accurate, especially if combined with an arthrogram (dye is added into the joint).. Cartilage flaps do not show on Xray.

Elbow Capsular Contracture

Loss of range of movement in the elbow may be due to conditions inside the joint (adhesions or bone deformity) or outside the joint (capsular contracture or bone bridge).The functional range is noted to be from 30° -120° and if this cannot be achieved then surgery may be considered.

The cause of capsular contracture may be :

• trauma
  • dislocation
  • fracture
  • congenital (from birth)

• acquired
  • osteoarthritis
  • inflammation
  • rheumatoid (inflammatory) arthritis
  • burns
  • septic arthritis
  • paralytic

The tightened soft tissue capsule and bony lumps which may be blocking the motion can be released from within the joint by the use of the arthroscope. However at times structures outside the joint space, such as tendons and muscles, may also be contracted and so in these cases open surgery may be undertaken at the same time.

Importantly the surgery is only part of the treatment and most important in these cases is the intense physiotherapy in the postoperative period to maintain and even stretch further the tissues after the formal release. A compliant patient who is committed to putting great effort during this period will get the best results.

Lasers can be used in the following Arthroscopic Surgery to the Elbow:

1. synovectomy
2. loose bodies
3. chondroplasty
4. osteoplasty
5. capsular release

Key Benefits

• No bleeding - therefore no tourniquet needed and less pain
• Small diameter instruments therefore less damage to surrounding tissues
• No moving parts therefore no chance of breakages in the joint