Treatments: Elbow surgery

These two conditions are forms of elbow tendon problems and can be extremely painful. If the pain does not respond to conservative treatment, such as rest, physiotherapy or a dry-needling procedure you may need surgery.

Open surgery is preferable to keyhole surgery because of the location of the problem. It is performed through a small wound on the affected side of your elbow. Damaged tendon is removed and the remaining healthy tendon is reattached to the bone, from which a tiny piece has been removed to improve blood flow and help the area heal faster.

If the pain does not respond to conservative treatment, such as rest, anti-inflammatories or an elbow brace, you may need surgery to remove the damaged tendon.

• Arthroscopic surgery is carried out using an arthroscope which is inserted into tiny incisions in the skin above the elbow. The surgeon removes damaged parts of tendon using tiny instruments and a camera inserted through the incisions.
• Open surgery is performed through a cut above the bone on the side of your elbow. Damaged tendon is removed and the remainder is reattached to the healthy part of the bone. A tiny piece of bone in your elbow may also be removed to improve blood flow which helps the area heal faster.

Stiffness in your elbow (referred to as a contracture) can be caused by injury to your elbow which can result in the soft tissues becoming tight. It may also occur after surgery due to the formation of scar tissue. Elbow arthritis can cause bony spurs to form and these can prevent the joint from moving smoothly.

You may be offered elbow debridement surgery (referred to as an OK procedure) to remove damaged tissue and bone that may be caught within the elbow joint. The procedure can also be used to remove bony spurs which can form due to arthritis, preventing the joint from moving smoothly.

An incision is made at the back of the elbow and any excess soft tissue, bone or bony spurs are removed to enable the joint to move smoothly again. You will normally be admitted to hospital overnight whilst wearing a temporary plaster cast to keep your arm comfortable and straight. The following day the plaster is removed and exercises are started. Usually a straight arm splint is worn at night for a few weeks after.

Ligaments are the strong bands of tissue that connect one bone to another across a joint. An ulnar collateral ligament (UCL) injury is an injury to one fo the major ligaments in the elbow. The ulnar collateral ligaments attach the upper arm humerus bone to the ulna bone of the forearm. A lateral injury, which occurs on the outside of the elbow, is more common than a medial one, which occurs on the inside.

If you have torn your ligament, you may require surgery to repair it if it does not heal with rest and strengthening exercises. Ligament reconstruction involves replacing a torn ligament with a tendon graft. This can either be a synthetic tendon, one from a donor or a tendon taken from your own body (the palmaris longus tendon taken from your forearm).

The biceps is the largest muscle in the front of your upper arm. The biceps tendon connects this muscle to the radius bone in the forearm. The biceps tendon can rupture, often when lifting heavy objects. If this happens you may hear a popping sound and feel pain and swelling at the front of elbow and upper forearm.

An operation to repair the tendon can help to restore strength to the arm and reduce pain and cramping. The distal biceps tendon is reattached to the forearm using a tiny bone implant which stops the tendon pulling away from the bone.

If you have had the injury for longer than four weeks (a chronic injury), you may need a tendon graft, which uses a tendon taken from another part of your body, or a donor tendon.

Elbow arthroscopy is keyhole surgery to repair damage to the elbow joint. The damage can be intra-articular, which is caused from within the joint. Arthritis and stress on the joint due to overuse are examples of this type of damage and can cause bits of cartilage or bone to break off and become lodged in the joint, restricting normal movement.

Arthroscopy allows the surgeon to look inside the joint using a tiny camera called an arthroscope. Through small incisions in the elbow, tiny surgical instruments are used to remove loose bodies inside the joint, including cartilage and pieces of bone. Thickened capsule and scar tissue can be divided to allow the joint to move more easily.

Elbow joint replacement surgery is a far less common procedure than shoulder joint replacement, which is now a routine procedure for severe shoulder pain. This is because elbow arthritis is less common and replacement elbow joints don’t tend to last as long as other types of joint replacement due to the difficulty in replicating the complexity of the joint.

Elbow joint replacement is normally reserved for patients with rheumatoid-type arthritis and older people who are suffering from other forms of severe arthritis. It is not generally considered suitable for active people.

Elbow joint replacement involves removing the damaged joint and replacing it with a prosthetic implant, secured in place with special bone cement.