Surgery for painful elbow joint arthritis, elbow instability, and tendonitis: Elbow replacement, ligament reconstruction and repair, and tendon surgery
Edited By: Thomas Trumble, M.D.
Last updated Friday, September 08, 2006
Figure 1 - In this anatomic specimen, the lateral collateral ligament (LCL) avulsion has been simulated and the ligament that has been disrupted and torn off the distal humerus is held in the forceps. One can now look directly into the elbow joint. Figure 2 - The tendon graft is held in a clamp and one loop of the graft has been woven through the ulna and now will be attached to the humerus to reconstruct the ligament. Figure 3 - Anterior posterior (AP) x-ray of a patient with rheumatoid arthritis.
Figure 4 - This is a lateral x-ray of a patient with rheumatoid arthritis.
Figure 5 - This is an APX of a patient with the implants in place for a total elbow replacement.
Figure 6 - This is an intra-operative photograph showing that the ulna nerve on the yellow vessel loop has been protected with the components in place looking at the back or posterior side of the elbow.
Figure 7 - Physical exam with trial components look like that are inserted prior to submitting the final component.
Figure 8 - This diagram of the lateral aspect of the elbow demonstrates the narrow attachment of the (ECRB). The surgeon needs to exam the patient to ascertain the diagnosis and determine if additional tests are necessary. Frequently, these can be treated by activity modification and bracing.
Figure 9 - This demonstrates a strap worn with a small cushion to apply pressure of the lateral side of the elbow. If conservative treatment with therapy is not effective, then surgery to detach and reattach the muscle at a region where it is under less tension can be highly effective. Figure 10 - In this figure, an incision is made on the lateral side of the lateral aspect of the elbow so that the ECRB can be detached from the lateral epicondyle where it is demonstrated degeneration and tearing and reinserted slightly distally so that it attaches in the forearm instead of at the elbow.
SummaryOverview This article reviews common painful conditions that affect the elbow joint, including elbow arthritis, instability, and tendonitis (tendinitis), and discusses several surgical procedures that can help relieve pain and restore function, such as total elbow replacement (arthroplasty), ligament repair and reconstruction, and tendon surgery.
The elbow is a critical joint for hand and upper extremity function. Three main problems that affect the elbow are:
1) Instability injuries due to ligament disruption
2) Arthritis
3) Tendonitis, commonly referred to as tennis elbow and golfer’s elbow, or lateral and medial epicondylitis, respectively
Instability injuries: These can occur in athletes such as patients with repetitive throwing or in individuals who have had a sudden fall. Key ligaments involved are the lateral collateral ligament and the medial collateral ligament, which act as hinge ligaments to maintain the stability of the elbow. The key elements to these reconstructive procedures are to restore the correct biomechanical function of the ligaments as seen in tendon grafts that are secured to the bone. The alignment of the ligament reconstruction is critical and a number of nerves are in close proximity to these ligaments. Therefore these cases require team experience dealing with elbow injuries. Rehabilitation is a key phase in the treatment of elbow problems.
Arthritis
Arthritis of the elbow can develop from repetitive trauma or severe forms of systemic arthritis such as rheumatoid arthritis. Once the clinical examination demonstrates pain and a limited range of motion, and x-rays confirm degeneration of the joint, part of or the entire elbow can be replaced. Patients benefit most from this surgery if they are well motivated and in good health.
Tendonitis
This typically occurs in the lateral or medial prominences that are known as the lateral and medial epicondyles. In this region, the muscles attach to a narrow segment of bone and repetitive stress can result in tearing and degeneration where the muscle attaches. For example, one muscle on the lateral side of the elbow, the extensor carpi radialis brevis (ECRB) attaches on a very narrow segment of the lateral epicondyle, and so is susceptible to this condition.
Surgery for Elbow Instability, Arthritis, and Tendonitis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment.
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