© 2019 by Orthopaedic Research Clinic Alaska

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The American Board of Orthopaedic Surgery

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Elbow

Elbow Procedures

The elbow is a hinge joint, much like the knee and hip, where two bones of the forearm (radius and ulna) meet the bone of the upper arm (humerus). Allowing you to bend and straighten your arm, wrist and fingers, the elbow has many ligaments and muscles working together with the bones to maintain healthy mobility. Experiencing elbow pain can disrupt your simple daily tasks.

Common injuries include tennis elbow, fractures and bicep tendon tears. ORCA advocates nonoperative care whenever possible but understand that operation may be the only solution.

 
Elbow Arthroscopy

Elbow arthroscopy refers to a surgical procedure that enables the physician to view the joint by making tiny incisions with small instruments. Most people are aware of shoulder and knee arthroscopy, but this procedure can also be used to treat issues with the elbow. The elbow is a joint that connects the forearm bones with the upper arm bone. Compared to conventional open surgery, the cuts made for elbow arthroscopy are smaller and less invasive. Elbow arthroscopy minimizes swelling and stiffness and facilitates a faster recovery.


Elbow arthroscopy can diagnose and treat issues with the elbow joint. Some of the conditions that elbow arthroscopy can diagnose and treat include stiffness, tennis elbow, fractures, arthritis, and loose components of the joint.


Injuries to the elbow like fractures can cause stiffness and discomfort of the joint. Elbow arthroscopy often proves to be an effective treatment for patients with contracted and stiff elbows. Arthroscopy cannot cure or reverse arthritis of the elbow. However, arthroscopy can help improve function and symptoms of arthritic elbow. After the physical examination, which may include CT or MRI scanning and x-rays, the surgeon will recommend a procedure to treat the elbow condition or disorder.


A surgeon will perform elbow arthroscopy on an individual under regional or general anesthesia. The surgeon will insert a small camera through an incision in the elbow. The lens of the camera will capture, magnify, and project the structures of the elbow to a monitor. This allows the surgeon to diagnose the disorder or condition. The surgeon will then make more small cuts to insert other small instruments and manipulate the camera to see other structures. The surgeon will use the small instruments to solve the issue.

Tennis Elbow

Tennis elbow refers to a condition that is usually caused by the overuse of the handle muscles, arm, and forearm. This overuse leads to elbow pain over time. While not all patients with tennis elbow play tennis, this condition is a serious issue for tennis players


Subtle or abrupt injury of the tendon and muscle area around the elbow is a common cause of tennis elbow. Oftentimes, tennis elbow involves the area where the tendons and muscles in the forearm attach to the lateral epicondyle of the elbow. Injury from overuse can impact the elbow’s posterior part as well.


Tennis elbow tends to occur in the dominant arm in an individual. For example, if an individual is right-handed, it is more likely that tennis elbow will occur in the right arm. However, it is possible that tennis elbow will occur in the non-dominant or both arms.


Some of the most common symptoms of tennis elbow include pain surrounding the elbow that occurs gradually or suddenly, worsening pain when squeezing objects, and worsening pain when moving or stabilizing the fist with force.
The vast majority of people recover from tennis elbow with conservative treatments. However, conservative treatment will not prove to be effective for some people. These people will need to undergo surgery to have the muscle-tendon unit in the elbow repaired.

 
Medial Collateral Ligament Reconstruction

A medial collateral ligament sprain is when the elbow is injured or damaged due to a valgus force that exceeds the tensile properties of the MCL. Throwing athletes are most at risk for a medial collateral ligament sprain. Usually, the main symptom of a medial collateral ligament sprain is pain of the medial elbow. Usually, this injury is very responsive to conservative treatment methods. However, in some cases, patients need to undergo surgery for recovery. Over the past two decades, the original surgical procedure for medial collateral ligament reconstruction has become less invasive due to the use of arthroscopy. The Modified Jobe technique and the Docking technique are both surgical procedures that can treat a medial collateral ligament sprain. The Docking technique is simply a modified version of the Modified Jobe technique.


A laterally directed force is the most common cause of elbow medial collateral ligament sprains. This force disrupts the elbow’s medial side and exceeds the MCL’s tensile properties. This injury is most common in volleyball, water polo, and tennis players. Javelin throwers, pitchers, and quarterbacks are also more likely to suffer from elbow medial collateral ligament sprains.


However, any elbow that experiences a sudden severe, valgus force can sustain an MCL injury—for example, this injury occurs frequently in wrestlers. MCL injuries can be acute or insidious. Regardless of the chronicity, these patients present with medial elbow pain. Understanding the differential diagnosis of medial elbow pain is paramount to diagnose MCL injury as well as addressing other medial elbow pathology.

 
 
Biceps Tendon Repair

The biceps is a muscle that is located on the front of the upper arm. The biceps muscle are attached to the bones of the elbow and shoulder by tendons, which are strong fibrous tissue responsible for attaching muscles to the bones.
Tears and injuries of the biceps tendon near the elbow are uncommon. A damaged biceps tendon is most commonly caused by sudden injury. Pain and arm weakness are two major symptoms of a damaged biceps tendon. Injuries to the biceps tendon near the elbow tend to be more serious than injuries to the biceps tendon near the shoulder. A biceps tendon tear can be complete or partial. A partial tear is when the soft tissue is damaged but the tendon is not severed. A complete tear will detach the tendon entirely from the attachment point on the bone. Most biceps tendon tears near the elbow are complete rather than partial, meaning the biceps tendon is detached entirely from the bone and pulled to the shoulder.


A torn or damaged biceps tendon near the elbow will not heal or grow back to the bone. However, the individual may still be able to bend their elbow well without the biceps tendon thanks to other arm muscles. However, an individual with a torn biceps tendon won’t be able to perform all of the elbow functions, such as supination, which involves rotating the forearm from palm up to palm down.


Surgery is often required to return arm strength to the healthy and original levels. However, individuals who don’t need full arm function may be able to cope with nonsurgical treatment.