Foreign bodies in the elbow

Definition of foreign bodies in the elbow:

Foreign bodies in the elbow are relatively frequent and can cause pain, cracking and even stiffness.
They can occur secondary to an elbow injury, as an evolution of osteoarthritis or spontaneously.

Video of treatment for foreign bodies in the elbow:

Video of elbow surgery showing the removal of a foreign body under arthroscopy / Specialist Toulouse

This CT arthrography shows an anterior loose foreign body that does not adhere to the capsule.
This other example shows a posterolateral foreign body adherent to the joint’s capsule, resulting from a radial head fracture.

Arthroscopic surgery of foreign bodies in the elbow, pre-operative CT arthroscopy, ToulouseArthroscopic surgery of foreign bodies in the elbow, pre-operative CT arthroscopy, Toulouse

 

Surgical treatment of foreign bodies in the elbow:

Treatment consists in arthroscopic removal. This demanding elbow surgery is specialized surgery.
This day surgery is usually performed under regional anaesthesia, witht the patient in the lateral decubitus position. Once the joint is injected with saline, the surgeon opens an antero-lateral portal for optics.
Shown here is the humero-ulnar joint space, with the coronoid apophysis, and it is possible to make out the humeroradial space. A bulky, loose, mobile anterior foreign body can be seen.

Arthroscopic surgery of foreign bodies in the elbow, operative setup, ToulouseArthroscopic surgery of foreign bodies in the elbow, the foreign body highlighted

An antero-medial instrumental portal makes it possible to fragment the foreign body with a burr.
It can then be removed with a grasper, after the opening in the capsule has been stretched.
When the foreign body is about to be removed, the surgeon modifies the cutaneous incision so that the foreign body doesn’t get caught in the subcutaneous soft tissues.

Arthroscopic surgery of foreign bodies in the elbow, retrieval of the foreign body, ToulouseArthroscopic surgery of foreign bodies in the elbow, extraction of the foreign body from the joint

Additional debridement or synovectomy procedures may be performed on an individual basis.
Here the surgeon performs a complete resection of the elbow’s anterior capsule, because preoperative stiffness was found along with a deficit in extension; an anterior osteophyte (bone spur) of the coronoid apophysis can also be removed.
Through posterior and posterolateral arthoscopic portals, it is also possible to remove a spur from the tip of the olecranon, and to debride the olecranon fossa.
At the end of the procedure, the surgeon confirms that full flexional range of motion is restored – extension and pronosupination.
The four surgical incisions are then closed with absorbable sutures.

Arthroscopic surgery of foreign bodies in the elbow, anterior synovectomy, ToulouseArthroscopic surgery of foreign bodies in the elbow, scar at 1 month, Toulouse

 

Recovery after surgery of foreign bodies in the elbow

Specific elbow rehabilitation must be started immediately to avoid any secondary stiffening of the joint.
Most daily life movements can resume after 3 weeks, forceful movements with the elbow must wait 6 to 8 weeks.

Arthroscopic surgery of foreign bodies in the elbow, sports resumes at 6 weeks, Toulouse