A Review of Indications and Techniques for Elbow Arthroscopy
Painful and arthritic elbows have been treated with a wide range of measures, ranging from medications to joint replacement. Currently, although primary degenerative arthritis of the elbow is not common, arthroscopic management of the problem is an interesting option for treatment.
Primary osteoarthritis of the elbow has been historically treated with anti-inflammatory medications or lifestyle modifications, while other treatments involved surgery. Total elbow arthroplasty, or replacement has not been very successful in younger patients because of loosening in the joint. Elbow arthrodesis (fusing) has been fairly successful but not always popular because it can restrict range of motion and affect quality of life. Other doctors have used debridement, removing of dead tissue, with some success as well. Arthroscopic debridement is being done more often, with good success in many patients.
For patients with rheumatoid arthritis in the elbow, treatment may involve open synovectomy, removal of the joint lining, and this can be done with arthroscopy with good results for patients with mild to moderate arthritis, limited motion, and pain.
Arthroscopic debridement is the treatment choice for septic arthritis.
For purposes of this article, the authors describe the procedure involved in arthroscopic debridement and then review the postoperative care, which involves keeping a splint in place to keep the arm in full extension and elevated over night. The next day, the splint is removed and after the patient is assessed, full active range of motion is allowed as tolerated.
In a study of patients with rheumatoid arthritis who underwent arthroscopic synovectomy, all 14 patients improved with pain but improvement in range of motion varied. In another study with the same procedure, 76 percent of the patients reported improvements in pain but fewer reported good range of motion. Finally, in a third study that compared arthroscopic synovectomy with open synovectomy, pain relief was superior (70 percent) in the open group than in the arthroscopic group (48 percent).
There was little information available on treatment of patients with septic arthritis, but one study of patients with posttraumatic arthritis showed a 79 percent improvement in pain among patients who underwent arthroscopic debridement.
The authors conclude that arthroscopic debridement is a useful treatment for arthritis in the elbow.
References: Julie E. Adams and Scott P. Steinman. Arthroscopy for elbow arthritis. In Current Orthopedic Practice. March/April 2008. Vol. 19. No. 2. Pp. 191-196.Back