Elbow Treatment

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Elbow Arthroscopy

Elbow - Know your Joint

  • Elbow joint is formed by a long bone of the arm known as the humerus and bones of the forearm radius and ulna.
  • It is a hinge joint.
  • Muscles attached to the bony elevations called medial and lateral Epicondyles help in the straightening of wrist and fingers (outer muscles) and in bending movements of wrist and grasping of objects (inner side muscles).
  • Elbow joint is supported by tendons and ligaments which hold the joint stable in place

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Indications of Elbow Arthroscopy

This procedure can be applied for a variety of conditions and can be useful in diagnosis as well as treatment for ailments such as:

  • Arthritis
  • Loose body removal
  • Tennis elbow
  • Stiffness
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Elbow arthroscopy may be recommended if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes

  • Rest
  • Physical therapy,
  • Medications or injections that can reduce inflammation.

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:

  • 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)
  • Elbow arthroscopy can also be used to repair lesions of the cartilage or for diagnostic purposes
  • Elbow fractures

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.

The procedure is more often used in patients where the issue does not require joint replacement surgery. Patients who have experienced sudden knee injuries or have twisted their knee perhaps while playing some sport that may have caused misalignment of the bones; the best treatment is generally arthroscopy. There are limited risks to the procedure and the outlook is good for most patients. Your recovery time and prognosis will depend on the severity of the knee problem and the complexity of the required procedure.

Post-Surgery Care and Recovery

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.

Limitations

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 humerus (upper arm bone),
  • The ulna (forearm bone on the pinky finger side),
  • The radius (forearm bone on the thumb side).

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.

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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.

Elbow replacement surgery is a complicated procedure partly because the elbow has several moving parts that balance each other with great precision to control the movements of your forearm. Moreover the elbow is a relatively small and complex hinge joint.

In elbow replacement surgery, the bone surfaces and cartilage that have been damaged are removed and replaced with artificial surfaces, called implants, often made of metal and very durable plastic material. One part fits into the humerus (upper arm) and the other part fits into the ulna (forearm). The two parts are then connected and held together by a locking pin. The resulting hinge allows the elbow to bend. The procedure is intended to give you restored motion and reduce painful bone-on-bone contact. The procedure is similar to hip and knee replacements.

There are different types of elbow replacements, and components come in different sizes. There are also partial elbow replacements, which may be used in very specific situations. The orthopedic and joint replacement surgeon will help to determine what type of elbow replacement is best for the patient.

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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 surgerywill 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.

Procedure

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.

Limitations

The most common complications are:

  • Infection
  • Injury to nerves and blood vessels
  • Allergic reaction to the artificial joint
  • Broken bone
  • Stiffness or instability of the joint
  • Pain

It is imperative that one should only consult an experienced and specialist Surgeon in Pune and undergo surgery only after complete diagnosis is done.



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