Shoulder and Elbow Surgery: Arthroscopy for degenerative disease of the elbow

The young patient with elbow arthritis poses significant difficulties in the treatment of the degeneration. Elbow arthroplasty or elbow fusion (which rarely used) are not good options for the young active patient. Elbow arthroplasty has a high rate of loosening and failure within 10 years due to the unique elbow loading during daily living activities. Lifting produces forces of distraction and rotation or torsion to the elbow which may lead to early loosening of the implant. The following case was treated with an elbow arthroscopic cartilage debridement in an attempt to "buy" time and postpone the elbow arthroplasty. She is in her 50s and has a remote history of forearm fracture that caused the arthritis to the elbow. She has 20-140 of flexion and her main problem at the time of presentation was the elbow pain. Preoperative XRs are shown below.

We prefer the lateral position on a bean bag as opposed to the prone position

Portals used are the proximal medial and anterolateral. The proximal medial portal was described by Dr Gary Poehling (I am thankful for his mentorship and training that I received from him on elbow arthroscopy)

Due to proximity of neurovascular structures the elbow arthroscopy is a procedure performed only by 7% of orthopaedic surgeons according to a survey contacted by the American Academy of Orthopaedic Surgeons. The key to avoid a nerve injury is the proper placement of the portals, avoidance of multiple attempts to re-establish the portals and distention of the joint capsule with 30cc of normal saline prior to establishment of the portals. Beginners in elbow arthroscopy should avoid arthritic elbows especially the ones with stiffness that are associated with trauma due to the higher chances of iatrogenic nerve injury.

Arthroscopic images of the elbow as shown below. The patient had significant relief of pain after this procedure.