I'm a little nervous about seeing the doctor next week for my elbow. Two years ago, I was thrown off a horse and fractured/dislocated my left elbow. After months of rehab, I still have a very stiff elbow with limited motion and even less strength. For me to lift a single bale of hay by myself is impossible. So I'm going back to the surgeon for an arthroscopic exam but wondering what I might be facing.
The surgeon will evaluate you carefully in order to determine the best way to conduct the arthroscopic surgery. The surgeon can enter the joint from the front (anterior approach) or from the back of the elbow (posterior). Swelling in the joint and/or scar tissue from previous surgeries can dictate which way the surgeon will begin.
When entering from the front, special care must be taken to avoid injury to any of the nerves in that area. Before beginning the operation, the surgeon may mark the skin of the patient. A black marker is used to identify all of the important soft tissues. During the procedure, fluid may be injected into the joint. This step helps increase the distance between nerves and other soft tissues.
Entering the joint from the back (posterior approach) gives the surgeon an entirely different view compared with an anterior approach. A different part of the capsule can be released from this direction.
The capsule around the joint has to be released to allow the surgeon access into the joint. Special surgical tools called retractors are used to pull the capsule away from the bone and allow the surgeon a better view inside the joint.
Whichever approach is used (and sometimes both anterior and posterior approaches are required), once inside, the surgeon gets busy. Any areas of debris, loose fragments of tissue, or scar tissue are cleaned up. Bone spurs are shaved off. This part of the procedure is called debridement.
Scar tissue from around the nerve is carefully scraped or cut away. This portion of the operation is the decompression. The surgeon will move the arm through its full motion while the patient is under anesthesia (manipulation). Anything that keeps the elbow from moving normally and fully is addressed.
You will probably leave the operating area with a soft dressing and a splint on the arm. Early movement is advised and hand therapy to reduce pain and swelling while maintaining and possibly improving motion begins immediately. It's likely you will continue in physical therapy for four to six weeks with a very active home program of exercise as well.
What kind of results can you expect? Experts agree that treating the stiff elbow (for whatever reason it develops) can be difficult with a high risk of complications. For example, infection and damage to the nerves and blood vessels are not uncommon problems. It seems the patients who have the best results start out with mild-to-moderate elbow stiffness and without heterotopic ossification (bone fragments that grow inside the muscle).
For carefully selected patients, arthroscopic treatment of the stiff elbow can be very effective. You may not get a perfectly normal elbow after surgery. But you can expect an elbow that moves enough to restore basic function.
You will be facing some hard work everyday to get smooth motion back and to keep it. Let your therapist know your daily activities and needs (e.g., lifting and carrying hay bales) so that you have a treatment plan that will help you reach those goals.
Jay D. Keener, MD, and Leesa M. Galatz, MD. Arthroscopic Management of the Stiff Elbow. In Journal of the American Academy of Orthopaedic Surgeons. May 2011. Vol. 19. No. 5. Pp. 265-275.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.