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ELBOW ARTHROSCOPY

It is a procedure for examining and treating some elbow problems by making small stab incisions and doing the needful, with the aid of an arthroscope and instruments.

Indications for elbow arthroscopy may be as below.

Removal of loose bodies
Synovitis, especially in a Rheumatoid patient
Osteochondritis dissecans
Capsular release, in a stiff elbow
Debridement of osteophytes, in the arthritic elbow
Radial head excision, in the Rheumatoid or the Osteoarthritic patient.

Anaesthesia

GA with Blocks (Scalene, Axillary)

Position

Lateral decubitus position, with the arm in a holder, is my favoured position. Other options for an elbow arthroscopy would be supine and prone positions.

Portal placement for elbow arthroscopy

It is important to mark the bony landmarks like Radial head, Olecranon and epicondyles. Also mark the positions of Ulnar nerve, Median nerve, Radial nerve and the brachial artery. The next step would be to inject the soft spot with 20 to 30 ml of saline, on the lateral aspect of the elbow of the elbow joint.

The anterior portals consist of the proximal medial, proximal (antero) lateral, (distal) antero-lateral and (distal) antero-medial portals. The ulnar, radial and the median nerves are very closely involved with these portals.

The posterior portals consist of the straight posterior and the postero-lateral portals

Instrumentation during elbow arthroscopy

The proximal medial portal is used to insert the arthroscope into the anterior aspect of the elbow joint and one of the lateral portals may be developed with an inside out technique. This portal may be used for instrumentation and these may be reversed to get a complete view of the anterior aspect of the joint.

For the posterior aspect of the elbow, the poster-lateral portal may be used for the arthroscope and the straight posterior portal may be used for instrumentation.

Elbow arthroscopy can be extremely beneficial to the patient in terms of quicker recovery, with minimal tissue damage. Careful attention to the anatomy is essential.