Arthroscopic management of arthritic elbow
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Transcript of Arthroscopic management of arthritic elbow
ArthroscopicTreatmentoftheArthriticElbow
AaronVenouziou,MDOrthopaedicHandandUpperExtremitySurgeon
St.Luke’sHospitalThessaloniki
www.handsurgery.gr
www.handsurgery.gr
Introduction
Arthroscopiculnohumeral /osteocapsular arthroplasty
•Removalofosteophytes
•Removalofanyloosebodies
•Capsulectomy
•Restorationofmotion&function
•Elimination/reductionpain
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Pathoanatomy
Typicallocationsofosteophytes
•Olecranon
•Olecranon fossa
•Coronoidprocess
•Coronoid fossa
•Radialhead
Anteriorandposteriorcapsulecontracture
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Indications
•Primaryosteoarthritis
•Post-traumaticarthritis
•ArthritisafterOCD
•Rheumatoidarthritis
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Contraindications
•Inadequateexperienceonelbowscope
•Priorulnarnervetransposition
•Severepost-traumaticarthritis
•Severejointsurfaceirregularities
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PatientEvaluation
•Laborers andathletes
•Painattheendofmotion
•Lossoffullextension
•Flexioncontracture
•Crepitus /locking
•Ulnarneuritissymptoms
History
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PatientEvaluation
•PosteriorImpingementTest
•ArmBarTest
ClinicalExamination
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Imaging
X-rays CTscan3D
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ArthroscopicTechnique
•Lateraldecubitus
•Armholder
•Shoulderforwardflexedat90o
•Shoulderslightlyabducted
•Non-steriletourniquet
Positioning
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ArthroscopicTechnique
•4-mm,30-degreescope
•Arthroscopicretractorsandgraspers
•Standardshaverandburr
•Suctionisplacedtogravityonly
Equipment
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ArthroscopicTechnique
• Getinandestablishaview
•Createaspaceinwhichtowork
•Boneremoval
•Capsulectomy
GeneralRules
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ArthroscopicTechnique
•PosteriorJointCompartment
•MedialGutter
•LateralGutter
•AnteriorJointCompartment
SequenceofElbowScope
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ArthroscopicTechnique
•Olecranon
•Lat.Epicondyle
•Radialhead
•Med.Epicondyle
•Ulnarnerve
Landmarks
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ArthroscopicTechnique
1. Getin: posterior,posterolateral,direct
midlateral portals
2. Createspace: synovectomy,removal
ofdebris,scartissue,andloosebodies
3. Boneremoval: osteophytesfrom
olecranon tip&fossa
4. Capsulectomy: uselargeshaver
PosteriorJointCompartment
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ArthroscopicTechnique
MedialGutter
1. Getin: posterolateralviewingportal,
posteriorworkingportal
2. Createspace: synovectomy,stayaway
fromtheulnarnerve
3. Boneremoval: osteophytesfrom
posteromedialolecranonw/shaver
4. Posteromedialcapsulectomy:⬆ flexion
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ArthroscopicTechnique
LateralGutter
1. Getin: posteriorviewingportal,
posterolateralworkingportal
2. Createspace: synovectomy,useofsoft
spotportal&RFdevice
3. Boneremoval: posteriorcapitellum,lateral
trochleaandolecranon,loosebodies
4. Posterolateralcapsulectomy:⬆ flexion
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ArthroscopicTechnique
AnteriorJointCompartment
1. Getin: anterolateral&anteromedial
portals,accessoriesportalsforretractors
2. Createspace: synovectomy,scartissue&
loosebodiesremoval
3. Boneremoval: osteophytesfromthe
coronoidtip/fossaandradialfossa
4. Anteriorcapsulectomy:medial➡ lateral
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ManagementoftheUlnarNerve
•Preoperativeulnarnervesymptoms
•Largerestorationofmotion
•Preoperativeflexion<100o
Whentoperformarelease:
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PostoperativeCare
• Posteriorsplintinfullextension
• Onpostopday5fullactiveROM
withnolimitationsispermitted
• Staticprogressive(turnbuckle)
splintfor4-6weeks
• PTfor2-3months
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Conclusions
• Overall,arthroscopictreatmentofthearthritic
elbowyieldsverygoodpainreliefandsignificant
improvementinjointrangeofmotion
• Indicationsstilldependonsurgeon’sarthroscopic
skills
• Proceedcautiouslyandrememberthat
WHENINDOUBTGETOUT
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