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The elbow is the synovial joint between the upper and lower parts of the arm. It is the point of articulation of three bones: the humerus of the arm and the radius and the ulna of the forearm. These bones give rise to two joints:
The humeroulnar and the humeroradial joints are the joints that give the elbow its characteristic hinge like properties. The elbow allows the forearm and hand to be moved towards and away from the body as well as rotation of the forearm and wrist.
The elbow forms from the expansion of the lower end of the humerus into two thick knobs, or condyles: the humerus’ dome-shaped lateral condyle articulates with a shallow depression on the end of the radius, and the humerus’ spool-shaped trochlea fits into a notch in the ulna. In addition to this, the edge of the radius’ head fits into a shallow groove on the side of the ulna. The bending and extension of the elbow joint are achieved, respectively, by contractions of the biceps and triceps muscles. These movements chiefly involve only the humerus and ulna; rotation of the forearm involves the smaller radius bone as well.
There is a collection of ligaments that connect the bones forming the elbow joint to each other, which aid in the stability of the joint. The humeroulnar and the humeroradial joints each have a ligament connecting the two bones involved at the articulation: the ulnar collateral and the radial collateral ligaments.
Similarly, like almost all other synovial joints, there is a thin layer of smooth articular cartilage that covers the ends of the bones that form the elbow joint. The joint capsule of the elbow surrounds the joint to provide strength and lubrication to the elbow. Slick synovial fluid produced by the synovial membrane of the joint capsule fills the hollow space between the bones and lubricates the joint to reduce friction and wear.
Often one can experience wear and tear in the elbow joint and it is a common site for injury. In such cases, orthopaedic treatments many be required to cure and treat elbow joint issues.
Arthroscopy is a procedure that allows orthopedic surgeons to inspect, diagnose, and repair problems inside a joint. Elbow arthroscopy is a sterile procedure that allows direct visualization of the elbow joint to diagnose and treat several elbow conditions. This procedure is most commonly used to release scar tissue, remove loose bodies or resurface the bone to decrease pain and improve range of motion.. The process involves making 1-2 cm small incisions (2-6) for insertion of an arthroscope – a pencil sized camera and other sleek instruments required to carry out the surgery. During the procedure fluid is pumped into the joint to allow for visualization and wash the joint of debris. Most people are aware of knee and shoulder arthroscopy, but the elbow joint has many conditions that can be treated with this procedure as well. Since the cuts made with elbow arthroscopy are smaller and disrupt less soft tissue than conventional open surgery, pain, swelling and stiffness are minimized, and recovery is often faster.
This procedure can be applied for a variety of conditions and can be useful in diagnosis as well as treatment for ailments such as:
Elbow arthroscopy may be recommended if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes
In an injured or diseased elbow joint, inflammation causes swelling, pain, and stiffness. 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. Elbow arthroscopy may also be recommended to remove loose pieces of bone and cartilage, or release scar tissue that is blocking motion.
Common arthroscopic procedures include:
Fractures and other injuries to the elbow can lead to significant stiffness in the joint. Stiff and contracted elbows are being released more frequently by elbow arthroscopy. Patients with arthritis of the elbow can enjoy significant improvement in symptoms and function after arthroscopy even if not completely cured. After physical examination and all pertinent diagnosis, including x-rays or other studies such as CT or MRI scanning as well as blood tests, your surgeon may recommend an arthroscopic procedure for treatment of your elbow disorder.
Patients who to undergo arthroscopic elbow surgery should avoid all anti-inflammatory medicines as well as medications that thin the blood 7-10 days prior to surgery to decrease intra-operative bleeding. Elbow arthroscopy is usually performed using general anesthesia, which allows muscle relaxation and placement of patient in prone or lateral decubitus position so the surgeon can perform the surgery.
Once the surgery is underway, the surgeon will first fill the elbow joint with fluid as this helps the surgeon to clearly see the structures of your elbow through the camera on the arthroscope. This also greatly reduces the risk of injury to the blood vessels and nerves surrounding your elbow joint. The surgeon will make several small incisions and a fiberoptic camera or arthroscope is inserted through a small cut in the elbow. The camera lens magnifies and projects the small structures in the elbow onto a television monitor, allowing the surgeon to accurately diagnose the condition. Several other small cuts in the elbow allow the surgeon to place the camera in different positions to see different structures inside the joint and to place various small instruments into the joint to help treat various problems.
Once the surgery is finished, you will be moved to the recovery room and monitored. Depending upon the procedure, the surgeon will place either an additional soft dressing that will allow movement or a plaster splint that will restrict movement and better protect the elbow. This procedure often allows the patient to go home the same day, but occasionally, depending on the condition, a hospital stay may be needed.
Though arthroscopy of the elbow is generally a safe treatment, this procedure too has risks as most other surgeries. These could include infection, nerve injury, bleeding, damage to other tissues, or require further more surgery. Elbow arthroscopy is not appropriate for all elbow conditions and is dependent on the surgeon’s training, expertise and comfort level.
The elbow is the synovial joint between the upper and lower parts of the arm and allows the forearm and hand to be moved towards and away from the body as well as rotation of the forearm and wrist.
The elbow is a hinge joint which is made up of three bones:
The surfaces of the bones where they meet to form the elbow joint are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the elbow joint. In a healthy elbow, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction as you bend and rotate your arm.Muscles, ligaments, and tendons hold the elbow joint together.
As the joint lining swells, the joint space narrows. The disease gradually destroys the bones and soft tissues. Usually, Rheumatoid Arthritis affects both elbows, as well other joints such as the hand, wrist and shoulder.
Osteoarthrits affects the cushioning cartilage on the ends of the bones that enables them to move smoothly in the joint. As the cartilage is destroyed, the bones begin to rub against each other. Loose fragments within the joint may accelerate degeneration.
Trauma or injury to the elbow can also damage the cartilage of the joint. This can lead to the development of arthritis in the injured joint.
If a severe disease such as rheumatoid arthritis or an injury has gravely harmed the elbow, the orthopedic doctor may recommend surgery to replace the joint, so there is less pain and better movement in the joint. You may need a joint replacement if your pain can’t be reduced enough by other treatments such as drugs, injections or physiotherapy and it’s hampering your daily activities.
When alternative course of treatments don’t offer relief to the patient, then surgery is the only next solution. Depending on the severity of the joint ailment, arthroscopic or total joint replacement surgery will be advised. One may have to go for elbow replacement surgery in case they have osteoarthritis or rheumatoid arthritis in the joint. Similarly severe fractures may also become a reason for elbow replacement surgery.
The surgeon will make an incision usually at the back of the elbow to reach the elbow joint. After making the incision, the muscles are gently moved aside to get access to the bone. After removing scar tissue and spurs around the joint, the surgeon will prepare the humerus to fit the metallic piece that will replace that side of the joint. The same preparation is done for the ulna.
The replacement stems are placed into the humerus and ulna bones, and kept in place with bone cement. The two stems are connected by a hinge pin. After the wound is closed, a padded dressing is then placed to protect the incision while it heals.
The most common complications are:
It is imperative that one should only consult an experienced and specialist orthopedic surgeon and undergo surgery only after complete diagnosis is done.