Osteoarthritis, a wearing down of the cartilage covering the ends of the bones, can develop in any joint of the body and the elbow is no exception. Elbow arthritis is generally characterized by loss of motion and pain in the elbow joint and tends to be more common in men who have had physically demanding jobs and/or have had elbow injuries in the past.
Osteoarthritis often develops differently in the elbow than in the knee or hip because the elbow is a non-weight bearing joint. With less pressure on the elbow joint, the cartilage does not wear down as quickly as in weight bearing joints, but secondary problems can develop even when the cartilage is well-preserved.
- Bone spurs (osteophytes) can develop around the periphery of the joint, limiting motion and causing pain with impingement.
- Bone spurs can break off, becoming loose bodies within the joint and leading to symptoms of catching or locking.
- Loose bodies within the elbow can further damage the joint over time, leading to progressive arthritis.
With severe osteoarthritis of the elbow, where the cartilage is significantly worn down, joint replacement (total elbow replacement) is an option for treatment. However, when the cartilage is well-preserved and pain and loss of motion is caused by the secondary problems described above, there is a better option for treatment: elbow arthroscopy.
Arthroscopic surgery of the elbow (or elbow scope) is a minimally invasive surgical technique which allows the surgeon to access, explore, and operate on the elbow joint through very small incisions. The use of an arthroscope (a small instrument containing a lens and fiber optic lighting system) connected to a camera allows the surgeon to see a magnified and enhanced view of the interior of the joint on a television screen, negating the need for a larger incision (open surgery).
Elbow arthroscopy is performed as an outpatient procedure and requires general anesthesia. Generally two to five 4mm incisions are made around the elbow for evaluation and treatment of the joint. Offending bone spurs are removed as well as any loose bodies. If a contracture of the joint is present, scarred tissue is resected to help regain lost motion. The entire procedure takes 60 – 90 minutes. Patients are discharged with a soft dressing and start physical therapy 2-3 days after the surgery. Complete recovery is expected in 6 to 8 weeks.
The main advantages of arthroscopic surgery over more traditional open procedures include:
- Improved visualization
- Decreased postoperative pain
- Decreased cost as an outpatient procedure vs overnight hospital stay
- Faster postoperative recovery
Please note: Elbow arthroscopy was initially proposed in 1931, but was not approved at the time due to the high risk of neurovascular injury. Since that time, we have seen vast improvements in our understanding of the complex anatomy of the elbow as well as in the surgical instruments available, and the procedure has become more widespread. However, this is a highly specialized procedure and it is recommended that you speak with your surgeon about his/her training and experience with elbow arthroscopy before opting for surgery.
Dr. Alexander S. Rowland is a board certified orthopaedic surgeon, fellowship trained in conditions of the hand, elbow, and shoulder, with The San Antonio Orthopaedic Group. He treats patients aged 6 years and older for conditions of the hand, wrist, and elbow and has a special interest in elbow arthroscopy, with over 250 cases performed. To schedule an appointment with Dr. Rowland, please call 210.281.9595.