Elbow
Total Elbow Replacement
Biceps Tendon Repair Surgery
What is Total Elbow Replacement?
Elbow Joint Replacement, also referred to as Total Elbow Arthroplasty is an operative procedure to treat the symptoms of arthritis that have not responded to non-surgical treatments.
The arm in the human body is made up of three bones that join to form a hinge joint called the elbow. The upper arm bone or humerus connects from the shoulder to the elbow forming the top of the hinge joint. The lower arm or forearm consists of two bones, the radius and the ulna. These bones connect the wrist to the elbow forming the bottom portion of the hinge joint.
Arthritis is a general term that covers numerous conditions in which the joint surfaces wear out. The joint surface is covered by a smooth articular surface made of cartilage that allows pain-free movement in the joint. This surface can wear out for several reasons. Often the definite cause is unknown.
When the articular cartilage wears out, the bone ends rub on one another causing pain. In general, but not always, arthritis affects people as they get older.
Why is total elbow replacement performed? Elbow joint replacement surgery may be recommended by your surgeon for the treatment of severe arthritis that has not responded to conservative treatment options such as medications or steroid injections.
Other indications for elbow joint replacement surgery may include:
- Severe elbow fracture in older patients with osteoporosis; a disease that causes bone loss and raises the risk of fractures- Tumour or growth in the elbow joint- History of previous elbow surgery Diagnosis Elbow conditions should be evaluated by an orthopaedic surgeon for proper diagnosis and treatment. Your surgeon will perform the following:
- Medical History- Physical Examination Tests will also be ordered and may include X-ray and MRI scan.
Surgical Procedure for total elbow replacement Elbow joint replacement surgery is an option that your surgeon may recommend if your overall health is good and you have not had success with conservative treatments options.
The goal of elbow joint replacement surgery is to eliminate your pain and increase the mobility of your elbow joint. The surgery is performed under sterile conditions in an operating room under general or regional anaesthesia and involves the following steps:
- An incision is made over the back of the elbow.- The muscles are retracted and tendons and ligaments are moved away to expose the elbow joint. Care is taken to move the ulnar nerve to prevent nerve damage.- The damaged joint surfaces of the humerus, radius and ulna are cut off with a surgical saw to create a smooth surface to attach the implants.- A special instrument is used to hollow out the inside of the humerus bone to insert the humeral component of the prosthesis.- Once a proper fit is established, the surgeon repeats this procedure on the ulna bone to prepare it for the ulnar component of the prosthesis.- The humerus and ulna bones are then prepared with or without cement, depending on the surgeon's preference.- The components are then inserted and put together ensuring proper movement of the hinge portion of the prosthesis.- With all the new components in place, the joint is tested through its range of motion.- The surgeon then irrigates the new joint with sterile saline.- The surgeon then sutures the joint capsule together, repairs the muscles and tendons and sutures the skin closed usually with a drain in place to help any blood drain from the area.- The elbow is then dressed and bandaged. Post-Operative Care following total elbow replacement After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed and the surgeon's preference.
Common Post-operative guidelines include:
- You will probably stay in the hospital 4-5 days after the surgery.- Your pain will be managed with a PCA machine (patient-controlled analgesia), injections, or pain pills. A PCA machine enables the patient to push a button to deliver a dose of pain medicine through their IV.- Your arm will be in a sling or splint with a bulky dressing- You may have a drain tube present to allow blood to drain from the incision. This will usually be removed after 1 or 2 days.- Elevating the elbow on a pillow above heart level and applying ice packs over the dressing will help reduce swelling and discomfort.- Occupational Therapy (OT) will begin soon after surgery and continue for about 3 months to regain full range of motion of the elbow joint.- Sutures will usually be removed after 10-14 days.- Keep the incision clean and dry. You may shower once the dressings are removed unless otherwise directed by your surgeon.- You will be given specific instructions regarding activity and rehabilitation.- Eating a healthy diet and not smoking will promote healing. Risks and Complications associated with total elbow replacement Most patients suffer no complications following Elbow Joint Replacement, however, complications can occur following elbow surgery and include:
- Infection- Fractures of the humerus or ulna bone- Dislocation of the elbow- Damage to nerves of blood vessels- Blood clots (Deep Venous Thrombosis- Loosening of artificial components- Wound irritation- Failure to relieve pain
The arm in the human body is made up of three bones that join to form a hinge joint called the elbow. The upper arm bone or humerus connects from the shoulder to the elbow forming the top of the hinge joint. The lower arm or forearm consists of two bones, the radius and the ulna. These bones connect the wrist to the elbow forming the bottom portion of the hinge joint.
Arthritis is a general term that covers numerous conditions in which the joint surfaces wear out. The joint surface is covered by a smooth articular surface made of cartilage that allows pain-free movement in the joint. This surface can wear out for several reasons. Often the definite cause is unknown.
When the articular cartilage wears out, the bone ends rub on one another causing pain. In general, but not always, arthritis affects people as they get older.
Why is total elbow replacement performed? Elbow joint replacement surgery may be recommended by your surgeon for the treatment of severe arthritis that has not responded to conservative treatment options such as medications or steroid injections.
Other indications for elbow joint replacement surgery may include:
- Severe elbow fracture in older patients with osteoporosis; a disease that causes bone loss and raises the risk of fractures- Tumour or growth in the elbow joint- History of previous elbow surgery Diagnosis Elbow conditions should be evaluated by an orthopaedic surgeon for proper diagnosis and treatment. Your surgeon will perform the following:
- Medical History- Physical Examination Tests will also be ordered and may include X-ray and MRI scan.
Surgical Procedure for total elbow replacement Elbow joint replacement surgery is an option that your surgeon may recommend if your overall health is good and you have not had success with conservative treatments options.
The goal of elbow joint replacement surgery is to eliminate your pain and increase the mobility of your elbow joint. The surgery is performed under sterile conditions in an operating room under general or regional anaesthesia and involves the following steps:
- An incision is made over the back of the elbow.- The muscles are retracted and tendons and ligaments are moved away to expose the elbow joint. Care is taken to move the ulnar nerve to prevent nerve damage.- The damaged joint surfaces of the humerus, radius and ulna are cut off with a surgical saw to create a smooth surface to attach the implants.- A special instrument is used to hollow out the inside of the humerus bone to insert the humeral component of the prosthesis.- Once a proper fit is established, the surgeon repeats this procedure on the ulna bone to prepare it for the ulnar component of the prosthesis.- The humerus and ulna bones are then prepared with or without cement, depending on the surgeon's preference.- The components are then inserted and put together ensuring proper movement of the hinge portion of the prosthesis.- With all the new components in place, the joint is tested through its range of motion.- The surgeon then irrigates the new joint with sterile saline.- The surgeon then sutures the joint capsule together, repairs the muscles and tendons and sutures the skin closed usually with a drain in place to help any blood drain from the area.- The elbow is then dressed and bandaged. Post-Operative Care following total elbow replacement After surgery, your surgeon will give you guidelines to follow depending on the type of repair performed and the surgeon's preference.
Common Post-operative guidelines include:
- You will probably stay in the hospital 4-5 days after the surgery.- Your pain will be managed with a PCA machine (patient-controlled analgesia), injections, or pain pills. A PCA machine enables the patient to push a button to deliver a dose of pain medicine through their IV.- Your arm will be in a sling or splint with a bulky dressing- You may have a drain tube present to allow blood to drain from the incision. This will usually be removed after 1 or 2 days.- Elevating the elbow on a pillow above heart level and applying ice packs over the dressing will help reduce swelling and discomfort.- Occupational Therapy (OT) will begin soon after surgery and continue for about 3 months to regain full range of motion of the elbow joint.- Sutures will usually be removed after 10-14 days.- Keep the incision clean and dry. You may shower once the dressings are removed unless otherwise directed by your surgeon.- You will be given specific instructions regarding activity and rehabilitation.- Eating a healthy diet and not smoking will promote healing. Risks and Complications associated with total elbow replacement Most patients suffer no complications following Elbow Joint Replacement, however, complications can occur following elbow surgery and include:
- Infection- Fractures of the humerus or ulna bone- Dislocation of the elbow- Damage to nerves of blood vessels- Blood clots (Deep Venous Thrombosis- Loosening of artificial components- Wound irritation- Failure to relieve pain
What is biceps tendon repair?
The biceps muscle is located in front of your upper arm. It helps in bending your elbow as well as in rotational movements of your forearm. Also, it helps to maintain stability in the shoulder joint. The biceps muscle has two tendons, one of which attaches it to the bone in the shoulder and the other attaches at the elbow. The biceps tendon at the elbow is called the distal biceps tendon and if there is a tear in this tendon, you will be unable to move your arm from the palm-down to palm-up position. Once the distal biceps tendon is torn, it cannot regrow back to the bone and heal by itself. Permanent weakness during rotatory movements of the forearm may occur if the tendon is not repaired surgically.
There are several procedures to accomplish reattachment of the distal biceps tendon to the forearm bone. Some techniques require two incisions while in others one incision may be sufficient. In some cases, the tendon is reattached using stitches passed through holes drilled in the bone. Sometimes, a small metal implant may be used to attach the tendon.
Surgical technique for biceps tendon repair During distal biceps tendon repair, your surgeon makes a small incision over the upper forearm, where the biceps muscle attaches to the radius bone. The torn biceps tendon is brought up through the incision. Then, the radius bone is prepared for tendon reattachment and to promote healing. Two suture anchors will be inserted into the bone. These serve as anchorage for the tendon. The sutures from the suture anchors are passed through the tendon in a particular interlocking manner so as to ensure a strong tendon repair.
Post-operative care following biceps tendon repair After the repair is complete, a hinged elbow brace will be applied with your elbow bent at 90 degrees. The brace will be removed after 6 weeks and it may take up to 6months -1 year to regain full strength.
Risks and Complications associated with biceps tendon repair Complications are rare and may include numbness and weakness in the forearm, the formation of new bone, limited movement, and re-tearing may occur.
There are several procedures to accomplish reattachment of the distal biceps tendon to the forearm bone. Some techniques require two incisions while in others one incision may be sufficient. In some cases, the tendon is reattached using stitches passed through holes drilled in the bone. Sometimes, a small metal implant may be used to attach the tendon.
Surgical technique for biceps tendon repair During distal biceps tendon repair, your surgeon makes a small incision over the upper forearm, where the biceps muscle attaches to the radius bone. The torn biceps tendon is brought up through the incision. Then, the radius bone is prepared for tendon reattachment and to promote healing. Two suture anchors will be inserted into the bone. These serve as anchorage for the tendon. The sutures from the suture anchors are passed through the tendon in a particular interlocking manner so as to ensure a strong tendon repair.
Post-operative care following biceps tendon repair After the repair is complete, a hinged elbow brace will be applied with your elbow bent at 90 degrees. The brace will be removed after 6 weeks and it may take up to 6months -1 year to regain full strength.
Risks and Complications associated with biceps tendon repair Complications are rare and may include numbness and weakness in the forearm, the formation of new bone, limited movement, and re-tearing may occur.
Elbow Arthroscopy
Elbow Dislocation
What is elbow arthroscopy?
Elbow arthroscopy, also referred to as keyhole or minimally invasive surgery is performed through tiny incisions to evaluate and treat several elbow conditions.
The Elbow is a complex hinge joint formed by the articulation of three bones - humerus, radius and ulna. The upper arm bone or humerus connects the shoulder to the elbow forming the upper portion of the hinge joint. The lower arm consists of two bones, the radius and the ulna. These bones connect the wrist to the elbow forming the lower portion of the hinge joint.
The three joints of the elbow are
- Ulnohumeral joint, the junction between the ulna and humerus- Radiohumeral joint, the junction between the radius and humerus- Proximal radioulnar joint, the junction between the radius and ulna The elbow is held in place with the support of various soft tissues including:
- Cartilage- Tendons- Ligaments- Muscles- Nerves- Blood vessels and- Bursae Indications of elbow arthroscopy: Elbow arthroscopy is usually recommended for the following reasons:
- Debridement of loose bodies such as bone chips or torn cartilage tissue- Removal of scar tissue- Removal of bone spurs: These are extra bony growths caused by injury or arthritis that damage the ends of bones causing pain and limited mobility. Arthroscopy is also used for the:
- Treatment of osteoarthritis, rheumatoid arthritis, and a condition called osteochondritis dissecans where loose fragments of cartilage and bone are in the joint space. Evaluation and diagnosis prior to elbow arthroscopy Your surgeon will review your medical history and perform a complete physical examination. Diagnostic studies may also be ordered such as X-rays, MRI or CT scan to assist in diagnosis.
Surgical procedure for elbow arthroscopy Arthroscopy is a surgical procedure in which an arthroscope, a small soft flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat a variety of conditions.
Elbow arthroscopy is commonly performed under general anaesthesia as an outpatient procedure. The patient is placed in a lateral or prone position which allows the surgeon to easily adjust the arthroscope and have a clear view of the inside of the elbow.
Several tiny incisions are made to insert the arthroscope and small surgical instruments into the joint. To enhance the clarity of the elbow structures through the arthroscope, your surgeon will fill the elbow joint with a sterile liquid.
The liquid flows through the arthroscope to maintain clarity and to restrict any bleeding. The camera attached to the arthroscope displays the internal structures of the elbow on the monitor and helps your surgeon to evaluate the joint and direct the surgical instruments to fix the problem.
At the end of the procedure, the surgical incisions are closed by sutures, and a soft sterile dressing is applied. Your surgeon will place a cast or a splint to restrict the movement of the elbow.
The advantages of arthroscopy compared to traditional open elbow surgery include:
- Smaller incisions- Minimal soft tissue trauma- Less post-operative pain- Faster healing time- Lower infection rate Post-operative care following elbow arthroscopy The post-surgical instructions include:
- Make sure to get adequate rest.- Raise your elbow on pillows above the level of the heart to help reduce swelling.- Keep the incision area clean and dry.- A compressive stocking may be applied from the armpit to the -hand once the dressing is removed to decrease pain and increase a range of motion.- Your doctor will prescribe pain medications to keep you comfortable.- Physical therapy will be ordered to restore normal elbow strength.- Eating a healthy diet and not smoking will promote healing. Risks associated with elbow arthroscopy The possible complications following elbow arthroscopy include infection, bleeding, and damage to nerves or blood vessels.
The Elbow is a complex hinge joint formed by the articulation of three bones - humerus, radius and ulna. The upper arm bone or humerus connects the shoulder to the elbow forming the upper portion of the hinge joint. The lower arm consists of two bones, the radius and the ulna. These bones connect the wrist to the elbow forming the lower portion of the hinge joint.
The three joints of the elbow are
- Ulnohumeral joint, the junction between the ulna and humerus- Radiohumeral joint, the junction between the radius and humerus- Proximal radioulnar joint, the junction between the radius and ulna The elbow is held in place with the support of various soft tissues including:
- Cartilage- Tendons- Ligaments- Muscles- Nerves- Blood vessels and- Bursae Indications of elbow arthroscopy: Elbow arthroscopy is usually recommended for the following reasons:
- Debridement of loose bodies such as bone chips or torn cartilage tissue- Removal of scar tissue- Removal of bone spurs: These are extra bony growths caused by injury or arthritis that damage the ends of bones causing pain and limited mobility. Arthroscopy is also used for the:
- Treatment of osteoarthritis, rheumatoid arthritis, and a condition called osteochondritis dissecans where loose fragments of cartilage and bone are in the joint space. Evaluation and diagnosis prior to elbow arthroscopy Your surgeon will review your medical history and perform a complete physical examination. Diagnostic studies may also be ordered such as X-rays, MRI or CT scan to assist in diagnosis.
Surgical procedure for elbow arthroscopy Arthroscopy is a surgical procedure in which an arthroscope, a small soft flexible tube with a light and video camera at the end, is inserted into a joint to evaluate and treat a variety of conditions.
Elbow arthroscopy is commonly performed under general anaesthesia as an outpatient procedure. The patient is placed in a lateral or prone position which allows the surgeon to easily adjust the arthroscope and have a clear view of the inside of the elbow.
Several tiny incisions are made to insert the arthroscope and small surgical instruments into the joint. To enhance the clarity of the elbow structures through the arthroscope, your surgeon will fill the elbow joint with a sterile liquid.
The liquid flows through the arthroscope to maintain clarity and to restrict any bleeding. The camera attached to the arthroscope displays the internal structures of the elbow on the monitor and helps your surgeon to evaluate the joint and direct the surgical instruments to fix the problem.
At the end of the procedure, the surgical incisions are closed by sutures, and a soft sterile dressing is applied. Your surgeon will place a cast or a splint to restrict the movement of the elbow.
The advantages of arthroscopy compared to traditional open elbow surgery include:
- Smaller incisions- Minimal soft tissue trauma- Less post-operative pain- Faster healing time- Lower infection rate Post-operative care following elbow arthroscopy The post-surgical instructions include:
- Make sure to get adequate rest.- Raise your elbow on pillows above the level of the heart to help reduce swelling.- Keep the incision area clean and dry.- A compressive stocking may be applied from the armpit to the -hand once the dressing is removed to decrease pain and increase a range of motion.- Your doctor will prescribe pain medications to keep you comfortable.- Physical therapy will be ordered to restore normal elbow strength.- Eating a healthy diet and not smoking will promote healing. Risks associated with elbow arthroscopy The possible complications following elbow arthroscopy include infection, bleeding, and damage to nerves or blood vessels.
What is elbow dislocation?
The elbow is a hinge joint made up of 3 bones – humerus, radius and ulna. The bones are held together by ligaments to provide stability to the joint. Muscles and tendons move the bones around each other and help in performing various activities. Elbow dislocation occurs when the bones that make up the joint are forced out of alignment.
What are the causes of elbow dislocation? Elbow dislocations usually occur when a person falls onto an outstretched hand. Elbow dislocations can also occur from any traumatic injury such as motor vehicle accidents.
What are the symptoms associated with elbow dislocation? When the elbow is dislocated you may have severe pain, swelling, and lack of ability to bend your arm. Sometimes you cannot feel your hand or may have no pulse in your wrist because arteries and nerves run along your elbow may be injured.
Diagnosis of elbow dislocation To diagnose elbow dislocation your doctor will examine your arm. Your doctor will check the pulses at the wrist and will evaluate the circulation to the arm. An X-ray is necessary to determine if there is a break in the bone. An arteriogram, an x-ray of your artery can be helpful to know if the artery is injured.
Treatment of elbow dislocation An elbow dislocation is a serious injury and therefore requires immediate medical attention. At home, you may apply an ice pack to the elbow to ease pain and swelling. However, it is important to see your doctor for help. You can also check if the arteries and nerves are injured or remain intact. You can feel your pulse by pressing tips of your fingers at the base of your wrist. They should turn white or blanch and a pink colour should come back in 3 seconds. To check for nerves, first, bend your wrist up and move your fingers apart and then touch your thumb to your little finger. You can also check for numbness all over your hand and arm. If you have a problem with any of these tests you need to see your doctor right away.
Your doctor will put your dislocated elbow back in place by pulling down your wrist and levering your elbow. This procedure is known as reduction. As it is a painful procedure you may be given medications to relieve your pain before the procedure. After the reduction, you may have to wear a splint to immobilize your arm at the elbow. After a few days, you may also need to do gentle motion exercises to improve the range of motion and strength.
Elbow dislocations may be prevented if you avoid falling on an outstretched arm or avoid situations that may cause falls such as walking at night or walking on slippery floors.
What are the causes of elbow dislocation? Elbow dislocations usually occur when a person falls onto an outstretched hand. Elbow dislocations can also occur from any traumatic injury such as motor vehicle accidents.
What are the symptoms associated with elbow dislocation? When the elbow is dislocated you may have severe pain, swelling, and lack of ability to bend your arm. Sometimes you cannot feel your hand or may have no pulse in your wrist because arteries and nerves run along your elbow may be injured.
Diagnosis of elbow dislocation To diagnose elbow dislocation your doctor will examine your arm. Your doctor will check the pulses at the wrist and will evaluate the circulation to the arm. An X-ray is necessary to determine if there is a break in the bone. An arteriogram, an x-ray of your artery can be helpful to know if the artery is injured.
Treatment of elbow dislocation An elbow dislocation is a serious injury and therefore requires immediate medical attention. At home, you may apply an ice pack to the elbow to ease pain and swelling. However, it is important to see your doctor for help. You can also check if the arteries and nerves are injured or remain intact. You can feel your pulse by pressing tips of your fingers at the base of your wrist. They should turn white or blanch and a pink colour should come back in 3 seconds. To check for nerves, first, bend your wrist up and move your fingers apart and then touch your thumb to your little finger. You can also check for numbness all over your hand and arm. If you have a problem with any of these tests you need to see your doctor right away.
Your doctor will put your dislocated elbow back in place by pulling down your wrist and levering your elbow. This procedure is known as reduction. As it is a painful procedure you may be given medications to relieve your pain before the procedure. After the reduction, you may have to wear a splint to immobilize your arm at the elbow. After a few days, you may also need to do gentle motion exercises to improve the range of motion and strength.
Elbow dislocations may be prevented if you avoid falling on an outstretched arm or avoid situations that may cause falls such as walking at night or walking on slippery floors.