Elbow surgery and arthroscopy

Origins of elbow arthroscopy:

Arthroscopic elbow surgery developed in the 1990s. Initially, elbow arthroscopy was only used to diagnose intra-articular pathologies. Thanks to surgical techniques and improvements, arthroscopy is no longer confined to diagnosis, but also provides a method to treat conditions of the elbow joint. The scope of elbow arthroscopy has also broadened to include extra-articular elbow conditions. 

Indications and elbow arthroscopy:

Elbow pathologies are relatively uncommon compared with the other pathologies of the upper limb, shoulder and hand. This partly accounts for slow progress and paucity of skills in arthroscopic elbow surgery.

Most intra-articular elbow pathologies can be accessed arthroscopically. This elbow surgery has greatly simplified the removal of foreign bodies from the elbow. Arthroscopy is also an option to treat some elbow fractures (radial head fractures, coronoid fractures) and keeps adhesions and stiffness to a minimum. Stiffness is indeed the main complication in elbow injuries and arthroscopy has made recovery much easier in articular release surgery and elbow arthrolysis.

An 4-mm diameter arthroscope is used.

Meanwhile, with improvements in instrumentation (surgical instruments) the use of arthroscopy to treat extra-articular elbow pathologies has spread, still with minimal postoperative adhesions and faster recovery:

- simple endoscopic ulnar neurolysis (nerve decompression) at the elbow and endoscopically-assisted ulnar nerve transposition.

- endoscopic repair of ruptures of the biceps at the elbow

- muscular release with endoscopic fasciotomy of chronic compartment syndromes at the forearm

 

Elbow arthroscopy, from diagnosis to treatment:

Elbow arthroscopy, which was originally a diagnostic technique, was first confined to the exploration of the intra-articular space and gradually broadened its scope to pathologies located further away from the elbow joint.

Arthroscopy setup in the lateral decubitus position

It was slow in its development and adoption, and was initially accused of causing severe complications: acute compartment syndrome, nerve lesions. In addition, it is performed with the patient in the decubitus lateral position, which does not make it an easy procedure.

We now know that complications are not more frequent with the arthroscopic procedure than with the traditional open procedure; when can we expect a lower complication rate?

Elbow arthroscopy, which used to be limited to exploration work, first made it simpler to remove intra-articular foreign bodies, and, soon, to perform articular release (arthrolysis) by making the aftermath simpler. These articular release procedures are all the more frequent at the elbow that this joint stiffens very quickly after an injury, even a minor one. With the introduction of minimally invasive fixation (osteosynthesis) systems, namely cannulated screws, some elbow fractures can now be treated and anchor systems make it possible to perform ligament and tendon repair surgery.

With the development of arthroscopic instrumentation and the simplification of its utilization, it has become possible to treat a significant number of per-articular elbow pathologies, ulnar nerve entrapment at the elbow being the most common of these, but also typical sporting pathologies such as the chronic compartment syndrome of the forearm or ruptures of the distal biceps reattached with suture anchors.

Peri-articular elbow arthroscopy and endoscopy are now surgical techniques that have demonstrated their relevance and their benefits to treat the diseases and injuries of the upper limb.