Elbow surgery is a specialized area of orthopedic medicine that treats injuries and conditions affecting the joint connecting the upper arm (humerus) to the forearm (radius and ulna). Because of the joint’s complex structure, which includes a dense network of ligaments, tendons, and nerves, procedures are tailored to address issues ranging from nerve compression to joint replacement.
Defining the Surgical Approaches
Orthopedic surgeons use two primary approaches to access the elbow joint. The traditional method is open surgery, which requires a larger incision for direct visualization and manipulation of the joint structures. This technique is generally reserved for complex repairs, such as setting severely fractured bones or performing a total joint replacement.
Alternatively, elbow arthroscopy is a minimally invasive technique, often called “keyhole surgery,” that uses an arthroscope, a small camera inserted through tiny incisions. Miniature surgical instruments are guided by the camera’s images displayed on a monitor. This approach is preferred for procedures like removing loose bone fragments, debriding damaged cartilage, or releasing scar tissue, often resulting in less pain and a faster recovery than open methods.
Common Procedures for Specific Conditions
Different elbow surgeries are named based on the specific anatomical problem they correct. Ulnar Collateral Ligament (UCL) Reconstruction, known as Tommy John surgery, replaces the torn ligament on the inner side of the elbow. This graft procedure uses a tendon harvested from another part of the patient’s body. It is primarily performed on overhead-throwing athletes to restore the medial stability necessary for high-velocity arm movement.
For patients suffering from end-stage arthritis or complex fractures, a Total Elbow Arthroplasty (TEA), or elbow replacement, may be necessary. This procedure involves removing the damaged ends of the humerus and ulna and replacing them with an artificial joint, typically made of metal and plastic, to relieve pain and restore motion.
When a fracture occurs, the repair is called Open Reduction and Internal Fixation (ORIF). Here, bone fragments are surgically realigned (reduction) and held in place using hardware like plates, screws, or wires (internal fixation).
Cubital Tunnel Release addresses nerve compression of the ulnar nerve. This nerve can become pinched as it passes through the cubital tunnel, causing numbness and tingling in the ring and little fingers. The surgeon performs a decompression by cutting the constricting ligament. Alternatively, the surgeon may perform a transposition, which moves the nerve to a less strained position.
Deciding When Surgery is Necessary
The decision to proceed with elbow surgery is usually determined by the severity of the injury or condition and a lack of response to non-operative treatments. For ligament injuries, surgery is typically reserved for complete tears or for athletes requiring a return to high-demand activities. For fractures, surgical fixation is indicated when bone fragments are significantly displaced, shattered (comminuted), or if the break has punctured the skin.
For chronic pain and limited mobility from degenerative conditions like arthritis, joint replacement is considered after physical therapy, injections, and medication have failed. The progression to bone-on-bone contact or severe joint destruction often makes arthroplasty the most reliable option for pain relief.
Nerve-related procedures, such as cubital tunnel release, are pursued when severe symptoms persist despite splinting and activity modification. Surgery is necessary in these cases to prevent permanent nerve damage, especially if progressive muscle weakness or atrophy is present.
Post-Surgical Care and Rehabilitation
Post-surgical care begins with protection, often involving a removable splint or sling to manage swelling and guard the surgical site. A general principle is to limit prolonged immobilization, as the elbow joint is highly prone to stiffness. Surgeons prioritize early, gentle range-of-motion exercises as soon as the stability of the repair allows.
Physical therapy is integrated into the recovery to restore strength and flexibility. For fracture repairs (ORIF), immediate mobilization is often encouraged for the best long-term results. However, total elbow replacement patients must adhere to lifelong lifting restrictions to protect the implant. Complex operations, such as UCL reconstruction, require the most extensive rehabilitation, often spanning nine to eighteen months before a safe return to competition.