The elbow is a complex joint formed by the joining 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 acts as a natural cushion to absorb forces across the joint. 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.
On the inner and outer sides of the elbow, thicker ligaments (collateral ligaments) hold the elbow joint together and prevent dislocation.
The elbow joint is surrounded by muscles on the front and back sides. In addition, the three major nerves that cross the elbow joint are located close to the joint surfaces and capsule and must be protected during arthroscopic surgery.
The elbow joint allows two basic movements: bending and straightening (flexion and extension) and forearm rotation (pronation — palm down, and supination — palm up).
Normal bending and straightening motion occurs at the joining of the humerus and ulna bones. Forearm rotation occurs at the joining of the ulna and radius and is also influenced by muscles and ligaments further down the forearm and at the wrist joint.
Your doctor may recommend elbow arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation. Inflammation is one of your body’s normal reactions to injury or disease. 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)
There are several elbow surgical treatments that are currently most effective when done as an open, traditional procedure. These include surgeries to:
- Treat golfer’s elbow (medial epicondylitis)
- Repair the collateral ligaments
- Fix many fractures
- Replace the elbow joint
- Decompress the ulnar nerve (funny bone nerve)
Some advanced surgeries combine arthroscopic and open procedures in the same setting. For example, in a severe case of osteochondritis dissecans, a loose piece of bone may be removed arthroscopically, and the damaged area of the humerus may be treated with a bone graft using an open surgical technique.
Once in the operating room, you will most likely be given general anesthesia, as well as intravenous antibiotics. Antibiotics are typically given before surgery to lessen the risk of infection after surgery.
You will then be positioned so that your surgeon can easily adjust the arthroscope to have a clear view of the inside of your elbow. The two most common positions for elbow arthroscopy are lateral decubitus (side lying) and prone (lying on your stomach). Care is taken to ensure that your spine and other pressure points in your arms and legs are protected and padded after positioning.
Next, a tourniquet is applied to your upper arm which is then placed in an arm holder to keep it in position during the procedure. A compressive dressing may be applied to your lower arm and hand to limit swelling. The surgical team will clean your skin with antiseptic and cover your shoulder and upper body with sterile surgical drapes.
Your surgeon will first fill the elbow joint with fluid. The fluid helps your surgeon more clearly see the structures of your elbow through the camera on the arthroscope. This lessens the risk of injury to the blood vessels and nerves surrounding your elbow joint. Your surgeon will make several small incisions to introduce the arthroscope and small instruments into the joint.
Fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen showing your surgeon the inside of your elbow and any problems. Your surgeon will evaluate the joint before beginning any specific treatments. If indicated, the entire joint will be evaluated, which may require a total of five or six very small arthroscopy incisions.
Once the problem is clearly identified, your surgeon will insert other small instruments through separate incisions to repair it. Specialized instruments are used for tasks like shaving, cutting, grasping, suture passing, and knot tying. In many cases, special devices are used to anchor stitches into bone.
The arthroscopy incisions are usually stitched or covered with skin tapes at the end of the surgery. An absorbent dressing is applied to the elbow. Depending upon the procedure, your 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.