Elbow Conditions and Surgical Procedures

Arthritis

Typical symptoms of elbow arthritis include:

  • Pain – Generally worse as you rotate the forearm.
  • As the condition progresses pain interrupts sleep during the night
  • Swelling (more common with rheumatoid arthritis)
  • Instability of the joint
  • Inability to extend or flex the elbow
  • Locking and stiffness

What does Elbow Arthroscopic Surgery involve?

  • Arthroscopic elbow surgery is designed at improving elbow stiffness and end range pain but not curing  arthritis.
  • It is a day procedure where Dr Herald can look inside the joint using a small cut with instruments the width of a pencil.
  • Spurs and loose bodies are removed and tight adherent capsules are released.
  • The benefit of arthroscopic surgery includes a quicker recovery as only small punctures through the skin are used to access the joint as opposed to formal, open incisions.
  • Improved elbow range is obtained under anaesthesia but extensive post operative rehabilitation is needed to maintain this.
  • Following surgery, a period of continuous elbow range of motion with a continuous passive motion (CPM) machine is required to maintain motion and prevent recurrent scarring.

What does Elbow Replacement Surgery involve?

  • Elbow replacement surgery is usually done if your doctor has assessed your elbow as being badly damaged by osteoarthritis or if the pain is persistent and severe and you cannot use your arm.
  • Surgery may also be appropriate may for patients with rheumatoid arthritis, a badly broken bone in the upper or lower arm near the elbow, badly damaged or torn elbow tissues, a tumor or a very stiff elbow.
  • During a total elbow replacement procedure, the damaged parts of the elbow-hinged joint are removed and replaced with artificial components called prostheses.
  • Replacement options include a hemiarthoplasty where part of the joint is replaced not the olecranon (the bony point of the elbow); a total elbow arthroplasty where the end of the humerus and olecranon is replaced with a metal and plastic hinged joint.
  • The decision as to which prosthesis is used is dependent on your surgeon, the degree of your arthritis and your age.
  • As the elbow is a much smaller joint than a knee or a hip there is generally a 3kg lifting restriction applied following surgery to prevent the plastic wearing out too soon.
Arthroscopy

What is elbow arthroscopy?

  • Arthroscopic elbow surgery is a day procedure where Dr Herald can look inside the joint using a small cut with instruments the width of a pencil.
  • Spurs and loose bodies are removed and tight adherent capsules are released.
  • The benefit of arthroscopic surgery includes a quicker recovery as only small punctures through the skin are used to access the joint as opposed to formal, open incisions.

What conditions is elbow arthroscopy useful for?

  • Elbow arthroscopy can be useful in diagnosis and treatment of arthritis, loose bodies in the joint, tennis elbow, stiffness and fractures.

What happens after the procedure? 

  • Improved elbow range is obtained under anaesthesia but extensive post operative rehabilitation is needed to maintain this.
  • Following surgery, a period of continuous elbow range of motion with a continuous passive motion (CPM) machine is required to maintain motion and prevent recurrent scarring.
  • The CPM machine is used in hospital for around 3 days continuously and for most of the day for up to a month after.
  • A physiotherapist is an important part of your post-operative rehabilitation.
Biceps tear (Distal Biceps Repair)

What is it?

  • The biceps muscle has two tendons which insert into the shoulder.
  • These muscles allow you to bend the elbow and rotate the arm.
  • A biceps tendon tear at the elbow is generally less common than a biceps tendon tear at the shoulder.

What are the symptoms?

  • Popping sounds at injury
  • This kind of injury often occurs on heavy lifting
  • Pain, tenderness and weakness at the shoulder or elbow
  • Trouble turning the palms face up or face down
  • Bruising
  • Bulging above the elbow
  • Sharp and sudden pain near the elbow

 What is the treatment?

  • A severe biceps tendon tear needs prompt treatment as the distal biceps tendon cannot regrow back to the bone and heal itself.
  • Permanent weakness can occur if the tendon is not repaired surgically and a deformed and high riding biceps muscle can cause you to lose more than half of your elbow strength.
  • For these reasons, surgical repair is most effective within first two weeks of symptoms.
  • There is about a 3 month recovery post surgery.
Lateral epicondylitis (Tennis Elbow)
  • Lateral epicondylitis is a painful condition that affects the muscles and tendons of the forearm.
  •  It is commonly referred to as “tennis elbow” but rarely occurs as a result
    of tennis these days.

Symptoms of this condition include:

  • Tenderness on the outer bony part of the elbow
  • Morning stiffness of the elbow with persistent aching
  • Soreness in the forearm
  • Pain worse when grasping or holding an object
  • The forearm tendons that attach to the outer aspect of the elbow may become inflamed and torn as result of repetitive over extension of the wrist and elbow.

What does surgery involve?

  • In most cases, the micro tears and inflammation settle down and heal with rest but in some recalcitrant cases surgery is required.
  • This involves repairing the torn extensor tendons after excising the degenerate segment and performing a tendon release.
  • Both result in reduced pain and increased grip strength.
  • A sling is required for comfort post-operatively and physiotherapy also.
Fractures

Elbow fractures commonly result from a fall, twisting injury or high impact accident and will be comfirmed by X-Rays and scans.

What are the symptoms?

  • Swelling, bruising and pain
  • An audible snap or pop at time of injury
  • Visible deformity or banana arm
  • Numbness or weakness in the arm, wrist and hand

There are three main type of elbow fractures including:

Head of The Radius Fracture

  • This injury usually causes pain with forearm rotation (palms turned up then down again).
  • These kind of fractures rarely require surgery to either fix or replace the radial head.


Olcrenon Fracture

  • These fractures are often displaced and almost all require surgery.
  • The bone fragments are re-aligned and held together with pins and wires or plates and screws.

    Distal Humerus Fractures
  • These fractures occur commonly in children and in the elderly.
  • Nerve and/or artery injuries can be associated with these types of fractures. These fractures usually require surgical repair with plates and/or screw, unless they are stable.

 

   Forearm Fractures

  • Dr Herald can also treat forearm fractures. There are several types of forearm fractures (sometimes severe breaks are called banana arm).
  • Forearm fractures typically account  for 4 in 10 childhood fractures.

What are the different types of forearm fractures?

  • Torus fractures –   In this injury, one side of the bone compresses, causing the other side to bend away from the growth plate. This is a stable fracture, meaning that the broken pieces of bone are still in position and have not separated apart (displaced).
  • Buckle Fractures – Also known as Metaphyseal fractures, these breaks frequently affect babies and toddlers. The fracture is across the upper or lower portion of the shaft of the bone and does not affect the growth plate.
  • Greenstick fracture. Another fracture of babies and young children, this is where soft bone breaks on one side and bends on the other – the euphemism refers to greenwood which also breaks when bent.
  • Galeazzi fracture. This injury affects both bones of the forearm. There is usually a displaced fracture in the radius and a dislocation of the ulna at the wrist.
  • Monteggia fracture. This requires urgent medical attention as it is a severe injury. It  affects both bones of the forearm – the ulna and the top (head) of the radius is dislocated.
  • Growth plate fracture. Because the growth plate helps determine the future length and shape of the mature bone, this type of fracture requires urgent attention. Trauma that would cause a sprain in an adult might actually fracture a growth plate in a child.