Minimally invasive treatment of elbow osteoarthritis and stiffness

Abstract

The treatment of elbow stiffness and arthritis has advanced from open to arthroscopic surgical procedures. Improvements in arthroscopic techniques have allowed outcomes of the treatment of elbow contracture and moderate degenerative arthritis to become comparable or exceed those of open treatments. Arthroscopic capsular release includes capsulotomy or capsulectomy of the anterior and posterior capsule with average improvement of 40° in the flexion-extension arc. Open limited ulnar nerve decompression is utilized in cases of significant flexion contracture (<100° elbow flexion) or preoperative ulnar nerve symptoms or a positive Tinel’s test. Arthroscopic resection of osteophytes, the coronoid and olecranon tips, and capsular release, or “arthroscopic osteocapsular arthroplasty,” have been shown to provide reliable improvements in pain relief, function, and range of motion in patients with moderate degenerative arthritis. Ulnar nerve limited decompression can be added for similar indications as those for an arthroscopic capsular release. Both procedures have a small but significant risk for complications including nerve injury. If a stepwise approach is utilized and significant surgical skills education in arthroscopic elbow techniques is obtained, then arthroscopic treatment of elbow stiffness and early arthritis is safe and reliable procedure, leading to predictable outcomes.