Elbow Arthroscopy

Elbow Arthroscopy - Scope It Out!

• Indications:
  • Loose body removal
  • Osteochondritis dissecans (OCD)
  • Synovitis (e.g., Rheumatoid Arthritis)
  • Articular cartilage defects
  • Stiff elbow (capsular release)
  • Lateral epicondylitis (tennis elbow) - debridement
  • Posterior impingement
• Contraindications:
  • Active infection
  • Severe bony ankylosis
  • Previous ulnar nerve transposition (relative)
  • Inadequate soft tissue envelope

⭐ Loose body removal is the most common indication for elbow arthroscopy.

📌 Mnemonic (Portals): "ALAS, My Poor Posterior Elbow" (Anterolateral, Anteromedial, Proximal Medial, Posterior, Posterolateral, Soft spot portal).

Elbow Arthroscopy - Joint Navigation

Elbow Arthroscopy - Inside Job

Key arthroscopic procedures performed inside the elbow joint:

• Loose Body Removal
  • Extraction of chondral, osteochondral, or bony fragments causing mechanical symptoms (locking, pain).
  • Commonly found in radiocapitellar joint or olecranon fossa.
• Osteophyte Debridement
  • Resection of impinging osteophytes, typically anterior (coronoid) or posterior (olecranon).
  • Improves range of motion in flexion and extension.
• Synovectomy
  • Removal of inflamed synovial tissue.
  • Indications: Inflammatory arthropathies (e.g., Rheumatoid Arthritis), pigmented villonodular synovitis (PVNS), symptomatic plica.
• Capsular Release
  • For arthrofibrosis/post-traumatic stiffness.
  • Anterior capsular release improves flexion; posterior release improves extension.
  • Target: Achieve functional arc of motion, often >100°.
• OCD (Osteochondritis Dissecans) Management
  • Treatment depends on lesion stability, size, and patient age.
  • Options: Retrograde drilling, antegrade drilling, microfracture, fragment fixation, or debridement.

Arthroscopic OCD Management Algorithm:

⭐ Arthroscopic capsular release for post-traumatic elbow stiffness is highly effective, targeting anterior (for flexion) and posterior (for extension) capsule, aiming for >100° functional motion arc.

Elbow Arthroscopy - Danger Zones

• Neurological Risks (Transient palsy ~5-10%):
  • Ulnar N.: Most common; posteromedial/direct posterior portals. Prevent: elbow flexion >90°.
  • Radial N.: Anterolateral portal. Prevent: portal distal/anterior to lat. epicondyle.
  • Median N./AIN: Anteromedial portal. Prevent: portal anterior to med. epicondyle.
  • PIN: Proximal anterolateral portal.
  • MABCN: Anteromedial portal.
• Vascular Risks: Brachial, radial arteries.
• General Prevention: Know safe zones; blunt dissection; maintain distension.

⭐ The ulnar nerve is the most commonly injured nerve during elbow arthroscopy, especially with posteromedial or direct posterior portals.

High‑Yield Points - ⚡ Biggest Takeaways

• Key Indications: Loose bodies, OCD (Osteochondritis Dissecans), synovitis, contracture release, and refractory epicondylitis.
• Portal Safety: Anteromedial (median n., brachial a.), Anterolateral (radial n.), Posterolateral (radial n./PIN).
• Ulnar nerve is highly vulnerable, especially with posterior or posteromedial approaches.
• Most frequent complication: Nerve injury (ulnar, radial, median).
• Effective for septic arthritis lavage and synovectomy in RA (Rheumatoid Arthritis).
• Contraindications include severe bony block and active overlying skin infection.