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Arthroscopic	Treatment	of	
the	Arthritic	Elbow
Aaron	Venouziou,	MD
OrthopaedicHand	and	Upper	Extremity	Surgeon
St.	Luke’s	...
www.handsurgery.gr
Introduction	
Arthroscopic	ulnohumeral /	osteocapsular arthroplasty
•Removal	of	osteophytes
•Removal	of...
www.handsurgery.gr
Pathoanatomy
Typical	locations	of	osteophytes
•Olecranon
•Olecranon fossa
•Coronoidprocess
•Coronoidfos...
www.handsurgery.gr
Indications	
•Primary	osteoarthritis
•Post-traumatic	arthritis	
•Arthritis	after	OCD
•Rheumatoid	arthri...
www.handsurgery.gr
Contraindications	
•Inadequate	experience	on	elbow	scope
•Prior	ulnar	nerve	transposition
•Severe	post-...
www.handsurgery.gr
Patient	Evaluation
•Laborers and	athletes
•Pain	at	the	end	of	motion
•Loss	of	full	extension	
•Flexion	...
www.handsurgery.gr
Patient	Evaluation
•Posterior	Impingement	Test
•Arm	Bar	Test
Clinical	Examination
www.handsurgery.gr
Imaging
X-rays CT	scan
3D
www.handsurgery.gr
Arthroscopic	Technique
•Lateral	decubitus
•Arm	holder
•Shoulder	forward	flexed	at	90o
•Shoulder	slightl...
www.handsurgery.gr
Arthroscopic	Technique
•4-mm,	30-degree	scope
•Arthroscopic		retractors	and	graspers
•Standard		shaver	...
www.handsurgery.gr
Arthroscopic	Technique
• Get	in	and	establish	a	view
•Create	a	space	in	which	to	work
•Bone	removal
•Ca...
www.handsurgery.gr
Arthroscopic	Technique
•Posterior	Joint	Compartment
•Medial	Gutter
•Lateral	Gutter
•Anterior	Joint	Comp...
www.handsurgery.gr
Arthroscopic	Technique
•Olecranon
•Lat.	Epicondyle
•Radial	head
•Med.	Epicondyle
•Ulnar	nerve
Landmarks
www.handsurgery.gr
Arthroscopic	Technique
1. Get	in: posterior,	posterolateral,	direct	
midlateral portals
2. Create	space...
www.handsurgery.gr
Arthroscopic	Technique
Medial	Gutter
1. Get	in: posterolateral	viewing	portal,	
posterior	working	porta...
www.handsurgery.gr
Arthroscopic	Technique
Lateral	Gutter
1. Get	in: posterior	viewing	portal,	
posterolateral	working	port...
www.handsurgery.gr
Arthroscopic	Technique
Anterior	Joint	Compartment
1. Get	in: anterolateral	&		anteromedial
portals,	acc...
www.handsurgery.gr
Management	of	the	Ulnar	Nerve
•Preoperative	ulnar	nerve	symptoms
•Large	restoration	of	motion
•Preopera...
www.handsurgery.gr
Postoperative	Care
• Posterior	splint	in	full	extension
• On	postop	day	5	full	active	ROM	
with	no	limi...
www.handsurgery.gr
Conclusions
• Overall,	arthroscopic	treatment	of	the	arthritic	
elbow	yields	very	good	pain	relief	and	...
www.handsurgery.gr
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Arthroscopic management of arthritic elbow

Arthroscopic management of arthritic elbow

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Arthroscopic management of arthritic elbow

  1. 1. Arthroscopic Treatment of the Arthritic Elbow Aaron Venouziou, MD OrthopaedicHand and Upper Extremity Surgeon St. Luke’s Hospital Thessaloniki www.handsurgery.gr
  2. 2. www.handsurgery.gr Introduction Arthroscopic ulnohumeral / osteocapsular arthroplasty •Removal of osteophytes •Removal of any loose bodies •Capsulectomy •Restoration of motion & function •Elimination / reduction pain
  3. 3. www.handsurgery.gr Pathoanatomy Typical locations of osteophytes •Olecranon •Olecranon fossa •Coronoidprocess •Coronoidfossa •Radial head Anterior and posterior capsule contracture
  4. 4. www.handsurgery.gr Indications •Primary osteoarthritis •Post-traumatic arthritis •Arthritis after OCD •Rheumatoid arthritis
  5. 5. www.handsurgery.gr Contraindications •Inadequate experience on elbow scope •Prior ulnar nerve transposition •Severe post-traumatic arthritis •Severe joint surface irregularities
  6. 6. www.handsurgery.gr Patient Evaluation •Laborers and athletes •Pain at the end of motion •Loss of full extension •Flexion contracture •Crepitus / locking •Ulnar neuritis symptoms History
  7. 7. www.handsurgery.gr Patient Evaluation •Posterior Impingement Test •Arm Bar Test Clinical Examination
  8. 8. www.handsurgery.gr Imaging X-rays CT scan 3D
  9. 9. www.handsurgery.gr Arthroscopic Technique •Lateral decubitus •Arm holder •Shoulder forward flexed at 90o •Shoulder slightly abducted •Non-sterile tourniquet Positioning
  10. 10. www.handsurgery.gr Arthroscopic Technique •4-mm, 30-degree scope •Arthroscopic retractors and graspers •Standard shaver and burr •Suction is placed to gravity only Equipment
  11. 11. www.handsurgery.gr Arthroscopic Technique • Get in and establish a view •Create a space in which to work •Bone removal •Capsulectomy General Rules
  12. 12. www.handsurgery.gr Arthroscopic Technique •Posterior Joint Compartment •Medial Gutter •Lateral Gutter •Anterior Joint Compartment Sequence of Elbow Scope
  13. 13. www.handsurgery.gr Arthroscopic Technique •Olecranon •Lat. Epicondyle •Radial head •Med. Epicondyle •Ulnar nerve Landmarks
  14. 14. www.handsurgery.gr Arthroscopic Technique 1. Get in: posterior, posterolateral, direct midlateral portals 2. Create space: synovectomy, removal of debris, scar tissue, and loose bodies 3. Bone removal: osteophytesfrom olecranon tip & fossa 4. Capsulectomy:use large shaver Posterior Joint Compartment
  15. 15. www.handsurgery.gr Arthroscopic Technique Medial Gutter 1. Get in: posterolateral viewing portal, posterior working portal 2. Create space:synovectomy, stay away from the ulnar nerve 3. Bone removal:osteophytes from posteromedial olecranon w/ shaver 4. Posteromedial capsulectomy:⬆ flexion
  16. 16. www.handsurgery.gr Arthroscopic Technique Lateral Gutter 1. Get in: posterior viewing portal, posterolateral working portal 2. Create space:synovectomy, use of soft spot portal & RF device 3. Bone removal:posterior capitellum, lateral trochlea and olecranon, loose bodies 4. Posterolateral capsulectomy:⬆ flexion
  17. 17. www.handsurgery.gr Arthroscopic Technique Anterior Joint Compartment 1. Get in: anterolateral & anteromedial portals, accessories portals for retractors 2. Create space:synovectomy, scar tissue & loose bodies removal 3. Bone removal:osteophytes from the coronoid tip / fossa and radial fossa 4. Anterior capsulectomy:medial ➡ lateral
  18. 18. www.handsurgery.gr Management of the Ulnar Nerve •Preoperative ulnar nerve symptoms •Large restoration of motion •Preoperative flexion < 100o When to perform a release:
  19. 19. www.handsurgery.gr Postoperative Care • Posterior splint in full extension • On postop day 5 full active ROM with no limitations is permitted • Static progressive (turnbuckle) splint for 4-6 weeks • PT for 2-3 months
  20. 20. www.handsurgery.gr Conclusions • Overall, arthroscopic treatment of the arthritic elbow yields very good pain relief and significant improvement in joint range of motion • Indications still depend on surgeon’s arthroscopic skills • Proceed cautiously and remember that WHEN IN DOUBT GET OUT
  21. 21. www.handsurgery.gr

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