The elbow is a complex hinge joint connecting the humerus (upper arm bone) to the radius and ulna (forearm bones). This structure allows for bending, straightening, and rotation of the arm. When the joint is significantly damaged by trauma, arthritis, or overuse, surgery is often required to restore function and alleviate pain. The specific surgical approach depends entirely on the structures damaged.
Keyhole Procedures: Elbow Arthroscopy
The least invasive option for addressing problems within the joint is Elbow Arthroscopy, often referred to as keyhole surgery. This technique uses a pencil-sized instrument called an arthroscope, which contains a camera and a light source. The surgeon inserts the arthroscope and specialized miniature instruments through several small incisions, typically only a few millimeters long, to visualize and treat the joint.
Surgeons use arthroscopy to remove loose bodies, which are fragments of bone or cartilage that can cause catching or locking of the elbow. It is also highly effective for treating joint stiffness by releasing scar tissue and removing bone spurs that limit the arm’s range of motion.
The technique is particularly beneficial because the smaller incisions generally result in less disruption to the surrounding soft tissues compared to traditional open surgery. This often translates to a faster recovery time and reduced post-operative pain. Elbow arthroscopy is also used to debride arthritic bone surfaces, which can smooth the joint and improve function, though it does not cure the underlying arthritis.
Joint Reconstruction and Replacement: Arthroplasty
When damage to the elbow joint is severe and irreparable, surgeons may turn to Arthroplasty, a procedure involving the replacement or resurfacing of the joint components. This approach is typically reserved for end-stage conditions, such as advanced rheumatoid arthritis, severe osteoarthritis, or complex, irreparable fractures, especially in older patients. Arthroplasty aims to provide a stable, pain-free elbow and restore a functional range of motion.
The most comprehensive form is Total Elbow Arthroplasty (TEA), which involves replacing the entire articulating surface of the joint with a prosthetic implant. Modern TEA implants are often linked, utilizing a “sloppy hinge” design that connects the humeral and ulnar components while allowing a slight amount of rotation to reduce stress on the bone-cement interface. Partial Elbow Arthroplasty, by contrast, replaces only the damaged section of the joint, such as the radial head, while preserving the healthy bone and soft tissues.
Unlike repair or cleaning procedures, arthroplasty implants prosthetic components into the joint. While TEA provides comprehensive joint restoration, it involves a longer rehabilitation process and is associated with risks like infection or loosening of the implant over time. However, for patients with debilitating pain and loss of function due to severe joint destruction, replacement can significantly improve quality of life.
Addressing Stability and Soft Tissue Injuries
A third group of procedures focuses on restoring the elbow’s structural integrity and treating soft tissue damage, often requiring traditional open surgery. One common intervention is Open Reduction Internal Fixation (ORIF), which is used to treat displaced or comminuted fractures of the humerus, radius, or ulna. During an open reduction, the surgeon manually realigns the broken bone fragments. Internal fixation then involves securing these fragments with specialized hardware, such as metal plates, screws, or wires, to ensure the bone heals in the correct position.
Soft tissue stabilization procedures frequently address ligament and tendon damage. A well-known example is Ulnar Collateral Ligament (UCL) reconstruction, commonly called “Tommy John Surgery,” which is performed primarily on overhead throwing athletes. This involves replacing the torn UCL with a tendon graft harvested from another part of the patient’s body. The graft is then woven through tunnels drilled into the ulna and humerus bones, stabilizing the joint against the intense forces of throwing.
Surgeries are also performed to relieve pressure on the nerves that run across the elbow. Ulnar nerve transposition addresses cubital tunnel syndrome, the second most common nerve compression condition. This procedure involves the surgeon carefully moving the ulnar nerve from behind the medial epicondyle to a new position, typically to the front, to prevent further irritation and relieve symptoms like numbness and weakness in the hand.