Warning Signs you may need Elbow Surgery
Patients may require surgical procedures in and around the elbow for a myriad of different reasons – there may be significant persistent pain or stiffness after an injury to the elbow that was managed non-surgically, there may be issues within the joint that are causing ongoing pain and difficulty with activities of daily living in the affected arm or the patient may have developed primary arthritis in or around the elbow joints which is limiting their range of motion and causing significant pain.
If any of these symptoms apply to you then you may need further assessment by a specialist orthopedic surgeon to determine exactly what the cause of these symptoms are and what the most appropriate management strategy will be.
Who is a good candidate for Elbow Surgery?
As previously mentioned, the most common reasons requiring elbow surgery are posttraumatic arthritis and/or deformity, development of osteochondral lesions or defects in and around the joints or primary elbow osteoarthritis causing pain and stiffness.
If you suffer from any of these conditions, then there are surgical procedures that we offer that could potentially be of significant benefit to you and we would encourage you to contact our surgeons if you feel that this may be the case.
Elbow Surgery Procedures
Depending on your diagnosis, you may be a candidate for one of a number of surgical procedures indicated in the treatment of conditions in and around the elbow. Below, we will cover some of the more common elbow complaints and how these can be addressed with surgery.
If you have experienced an injury or some type of fracture in and around the elbow in the past and it has gone on to heal, but developed either posttraumatic arthritis or deformity that is causing ongoing stiffness and pain then you may be a candidate for elbow replacement surgery.
Generally speaking, elbow replacement surgery is reserved for patients who have a very low level of physical demand in their activities of daily living as the postoperative restrictions from a total elbow replacement include lifting not greater than 5 pounds of weight in the operative arm for life. They are also generally restricted to patients who are older, given that these patients are more likely to live more sedentary lifestyles and that will put less strain on the components of the elbow replacement itself.
Certain conditions such as osteochondral lesions or loose bodies in and around the elbow joint may be addressed via arthroscopic surgery of the elbow. This involves placing a camera into the elbow in a similar fashion to placing cameras in other joints such as the knee or the shoulder. We visualize the joint itself, diagnose the underlying issue and subsequently treat it through various potential surgical means.
This is a common surgical procedure to have in the elbow and usually is suitable for most patients with no real age restriction to the procedure and no conditions of low level of activity or demand in and around the elbow in terms of the patient’s activities of daily living.
Patients who have elbow arthritis that is primary in nature and not as a result of an injury to the elbow may also be candidates for elbow replacement surgery. However, there are a number of other surgical procedures that can address things like stiffness and pain which can include replacements of specific parts of the joint (such as the radial head) or procedures that involve removing significant blocks to range of motion including major osteophytes, abnormal anatomy and deformities, and excision of the elbow capsule itself.
Elbow Surgery Complications and Risks
Each procedure that we have mentioned carries its own specific set of risks and complications that go with it. For example, total elbow arthroplasty patients must be counseled with regards to the limitations of the implants in total elbow arthroplasty and must adhere to the postoperative restrictions placed upon them. If they do not adhere to these restrictions, research has shown that elbow arthroplasty components have a higher level of aseptic loosening which may lead to revision surgery in the elbow, which is associated with poorer outcomes.
Elbow arthroscopy has a significant list of potential complications that mostly involve the nerves and blood vessels surrounding the elbow and the various arthroscopic portals that may be used to address problems in the elbow using the arthroscopic instruments.
As with any surgery, infection and injuries to nerves and blood vessels are always complications to be aware of and in patients who undergo surgery for elbow arthritis, the risk of heterotopic ossification should also be discussed. Surgeons can minimize these risks using either postoperative antiinflammatory medication regimens, or radiation therapy.
As with many arthroscopic procedures, elbow arthroscopy recovery is usually fairly swift – within two to six weeks following the surgery the patient should be back to their baseline level of function with hopefully improved levels of pain or reduction of preoperative symptoms.
More invasive procedures such as elbow arthroplasty carry with them a higher rate of complication and the standard arthroplasty complication discussion should be had with the patient including heart attack, blood clots, stroke, infection, neurovascular injury, aseptic loosening and the possibility of intraoperative fracture.
Fortunately, these complications are also very rare and ultimately successful surgery will mean that full recovery is usually achieved by most patients by around 3 to 6 months.
Elbow Surgery Recovery Exercises
One of the most important things to stress to the patient when discussing elbow surgery is the importance of maintaining good range of motion in the elbow for as long as possible and not succumbing to postoperative stiffness as the elbow joint is want to do whenever surgical procedures are undertaken in and around this area. It will most likely be necessary to undergo some form of physical therapy and this will focus on maintenance of range of motion in both supination, pronation, flexion and extension.
One of the most common complications experienced by patients irrespective of their elbow surgery is loss of terminal extension of the elbow, i.e., not being able to fully straighten their arm afterwards. This is usually resolvable with early and aggressive physical therapy, but some patients may notice that they lose terminal 5 to 10 degrees of extension and this is very common in the setting of elbow surgery and should not be considered a failure of the surgical procedure.
Elbow surgery is remarkably different from any other part of the body and the elbow joint itself is very unique in terms of its anatomy and function. As such, each elbow surgery should be customized and tailored to the patient specifically as well as their underlying complaints and each specific procedure will be associated with a series of specific complications and risks, all of which should be explained to the patient fully during the consenting process.
With that being said, elbow surgery is not for everyone and there are a number of conditions that can be managed conservatively without any kind of surgical procedure. If you have concerns about any elbow symptoms you might be experiencing, we encourage you to contact us at our offices and arrange to see one of our specialist orthopedic surgeons who will fully assess you and explain your diagnosis to you, including discussion of any potential surgical procedures that may be an option to you as well as alternative nonsurgical management strategies.