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Arthroscopic Treatment of Stiff Elbow  [PDF]
Davide Blonna,Enrico Bellato,Eleonora Marini,Michele Scelsi,Filippo Castoldi
ISRN Surgery , 2011, DOI: 10.5402/2011/378135
Abstract: Contracture of the elbow represents a disabling condition that can impair a person's quality of life. Regardless of the event that causes an elbow contracture, the conservative or surgical treatment is usually considered technically difficult and associated with complications. When the conservative treatment fails to restore an acceptable range of motion in the elbow, open techniques have been shown to be successful options. More recently the use of arthroscopy has become more popular for several reasons. These reasons include better visualization of intra-articular structures, less tissue trauma from open incisions, and potentially the ability to begin early postoperative motion. The purpose of this paper is to review the indications, complications, and results of arthroscopic management of a stiff elbow. 1. Introduction The main functions of the elbow are to position the hand in space and to act as a stabilizer for actions such as carrying, throwing, pushing, pulling, and lifting. In order to accomplish its function the elbow needs a full or almost full range of motion (ROM). The normal arc of motion of the elbow is from 0 to 145 degrees of flexion [1]. In a biomechanical study Morrey [2] concluded that an arc of motion between 30 and 130 degrees is enough to achieve 90% of the activities of daily living excluding sports and work activities. Consequently, a stiff elbow has been defined as an elbow with a reduction in extension greater than 30 degrees and/or a flexion less than 120–130 degrees [3]. Stiffness of the elbow is not a rare event and it can frequently lead to significant functional impairment which can be challenging to treat. This makes prevention mandatory. However, if prevention fails, a nonoperative treatment, such as physiotherapy or splitting, is usually recommended as the first therapeutic approach. After at least 6 months of such an unsuccessful conservative treatment, surgery may be indicated [4]. For many years open capsular release had been the standard treatment for elbow contractures [5]. More recently the use of arthroscopy has become more popular for several reasons including better visualization of intra-articular structures, less tissue trauma from open incisions, and potentially the ability to begin early postoperative motion [5–7]. The worldwide use of arthroscopic techniques has resulted in reports of intraoperative nerve injuries. These severe complications have led some authors to raise serious concerns about the safety of this procedure [5]. The aim of this paper is to review the etiologies, indications, complications,
Tratamento artroscópico da rigidez pós-traumática do cotovelo Arthroscopic treatment of post-traumatic elbow stiffness  [cached]
Jose Carlos Garcia Júnior,Jose Luis Amim Zabeu,Ivaldo Angelo Cintra Junior,Carlos Augusto Mattos
Revista Brasileira de Ortopedia , 2012, DOI: 10.1590/s0102-36162012000300008
Abstract: OBJETIVO: Avaliar pacientes submetidos à artroscopia para libera o do cotovelo rígido, discutindo a técnica, possíveis dificuldades e riscos. MéTODOS: Foram realizadas 24 artroscopias de cotovelos. Todos os pacientes foram avaliados usando goniometria pré e seis meses pós-cirurgia e pontuados com o escore de cotovelo Mayo. RESULTADOS: Operados 15 homens e nove mulheres, 14 cotovelos direitos e 10 esquerdos, média de idade de 34,58 anos e de tempo de seguimento de 38,41 meses. A média do ganho do arco de movimento foi de 43,3o e MES de 85,4. CONCLUS O: A libera o artroscópica pode viabilizar melhor visualiza o e aumento das op es de mudan a de estratégia durante a cirurgia, diminui o do trauma cirúrgico e possibilidade de reabilita o precoce, podendo atingir resultados similares ou melhores que os da cirurgia aberta. Contra a artroscopia há a grande curva de aprendizado e o maior custo do procedimento. Ambas as técnicas relatam complica es neurovasculares. Para evitar tais problemas, o protocolo para realiza o dos portais deve ser rigorosamente seguido. A libera o artroscópica mostrou ser op o segura e eficaz no ganho da ADM no cotovelo rígido pós-traumático. To evaluate patients undergoing arthroscopic release of a stiff elbow, with discussion of the technique, possible difficulties and risks. METHODS: Twenty-four elbow arthroscopy procedures were performed. All the patients were evaluated using goniometry before the operation and six months after wards and were rated using the Mayo elbow performance score (MEPS). RESULTS: Fifteen men and nine women underwent surgery (14 right elbows and ten left elbows). Their mean age was 34.58 years and length of follow-up, 38.41 months. Their mean gain of range of motion was 43.3o and of MEPS, 85.4. CONCLUSION: Arthroscopic liberation might enable better intrarticular visualization and enhance options to change strategy during surgery, reduction of surgical trauma and possibility of early rehabilitation, and this technique can reach similar or better results than open surgery. Disadvantages of arthroscopy are lack of ability of surgeons and higher cost of procedure. Both techniques report neurovascular complications, to avoid such problems the arthroscopic portals protocols must be rigorously followed. Arthroscopic release of the stiff elbow can enable range of motion gain, and also promotes high level of satisfaction by the decrease of pain and good cosmetic appearance. Some cases might demand adjuvant treatments. When correctly indicated, arthroscopy may be a safe surgical option with satisfactory outcom
Elbow Arthroscopy: Review of the Literature and Case Reports  [PDF]
Prakash Khanchandani
Case Reports in Orthopedics , 2012, DOI: 10.1155/2012/478214
Abstract: Elbow arthroscopy, though described first in 1930s, gained popularity only in the last 3 decades. There has been a steady expansion in the clinical applications of elbow arthroscopy owing to the significant improvements in instrumentation and arthroscopic skills. The procedure which was mainly used for diagnostic purpose, loose body removals, and synovial biopsy has now become an important tool for managing elbow arthritis, stiff elbow, and trauma. However, this procedure has a higher incidence of neurological complications and hence case selection and surgeon’s expertise are of utmost importance. 1. Introduction Elbow arthroscopy has gained popularity steadily over the last three decades. Though elbow arthroscopy still remains a relatively uncommon procedure to a general orthopaedist; current advanced equipment, increasing experience, and newer techniques have made it a safe and effective tool for diagnosis and treatment of elbow problems [1]. Arthroscopic expertise and anatomical precision are mandatory to establish a safe and reproducible procedure [1, 2]. Till about a decade back elbow arthroscopy was used mainly for loose body removals and diagnostic arthroscopy of the painful elbow [2]. However, present decade has seen significant expansion in the indications of elbow arthroscopy ranging from traumatic elbow pathologies to the arthritic elbow [3]. 2. Case Reports Case 1. A 40 year old male, carpenter by profession, presented to us with pain in left elbow since 2 years following a fall. The pain was sharp to dull aching and localized mainly to the posterolateral aspect of elbow. To start with, the pain was not significant; however it had deteriorated since last 2 months and was aggravated during heavy works, thus affecting his activity of daily living significantly. On clinical examination, range of motion of elbow was full but painful after 110 degrees of flexion and during pronation/supination. There was no localized swelling and local rise of temperature. Local tenderness was noted on the posterolateral aspect of elbow especially over the anconeus triangle. At the time of presentation, visual analogue scale score for pain was 10 during heavy activities and 7 during light work. There was no neurovascular deficit. Plain radiographs and blood investigations were normal. Diagnostic elbow arthroscopy was planned. With patient in lateral decubitus position and elbow hanging on the arm holder, elbow arthroscopy was done with a 4?mm 30 degree arthroscope. By using direct lateral portal (Figure 1) in anconeus triangle as the viewing portal,
Post-traumatic flexion contractures of the elbow: Operative treatment via the limited lateral approach
Mark D Brinsden, Andrew J Carr, Jonathan L Rees
Journal of Orthopaedic Surgery and Research , 2008, DOI: 10.1186/1749-799x-3-39
Abstract: Surgical release of post-traumatic flexion contracture of the elbow was performed in 23 patients via a limited lateral approach. All patients had an established flexion contracture with significant functional deficit. Contracture types were classified as either extrinsic if the contracture was not associated with damage to the joint surface or as intrinsic if it was.Overall, the mean pre-operative deformity was 55 degrees (95%CI 48 – 61) which was corrected at the time of surgery to 17 degrees (95%CI 12 – 22). At short-term follow-up (7.5 months) the mean residual deformity was 25 degrees (95%CI 19 – 30) and at medium-term follow-up (43 months) it was 32 degrees (95%CI 25 – 39). This deformity correction was significant (p < 0.01). One patient suffered a post-operative complication with transient dysaesthesia in the distribution of the ulnar nerve, which had resolved at six weeks. Sixteen patients had an extrinsic contracture and seven an intrinsic. Although all patients were satisfied with the results of their surgery, patients with an extrinsic contracture had significantly (p = 0.02) better results than those with an intrinsic contracture. (28 degrees compared to 48 degrees at medium term follow up).Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe technique, which reliably improves extension especially for extrinsic contractures. In this series all patients with an extrinsic contracture regained a functional range of movement and were satisfied with their surgery.Elbow Stiffness with loss of function is a common disabling problem that usually arises as a complication of trauma [1-5], but may also occur following burns[6,7]. or head injury [8,9] or in association with degenerative, inflammatory or haemophiliac [10] arthropathy and congenital malformations [11]. The degree of stiffness is related to the severity of the injury and the duration of immobilisation at initial treatment [12,13]. Loss of elbow ex
Early arthroscopic release in stiff shoulder  [cached]
Sabat Dhananjaya,Kumar Vinod
International Journal of Shoulder Surgery , 2008,
Abstract: Purpose: To evaluate the results of early arthroscopic release in the patients of stiff shoulder Methods: Twenty patients of stiff shoulder, who had symptoms for at least three months and failed to improve with steroid injections and physical therapy of 6 weeks duration, underwent arthroscopic release. The average time between onset of symptoms and the time of surgery was 4 months and 2 weeks. The functional outcome was evaluated using ASES and Constant and Murley scoring systems. Results: All the patients showed significant improvement in the range of motion and relief of pain by end of three months following the procedure. At 12 months, mean improvement in ASES score is 38 points and Constant and Murley score is 4O.5 points. All patients returned to work by 3-5 months (average -4.5 months). Conclusion: Early arthroscopic release showed promising results with reliable increase in range of motion, early relief of symptoms and consequent early return to work. So it is highly recommended in properly selected patients. Level of evidence: Level IV
Arthroscopic study of the elbow joint in dog cadavers
Tatarunas, Angelica Cecilia;Matera, Julia Maria;
Acta Cirurgica Brasileira , 2006, DOI: 10.1590/S0102-86502006000600002
Abstract: purpose: to study the arthroscopic technique of the elbow joint in dog cadavers. the possibility to see the intra articular structures, technical difficulties and complications which occurred during the procedure were analyzed. methods: ten dog's cadavers (twenty elbow joints) were examined. both, arthroscopic and instrumental portals were performed on the medial site of joint at caudal and cranial positions, respectively. results: we could see the totality of the proposed structures. the main complications were cartilage iatrogenic lesion and periarticular infiltration. conclusion: the elbow arthroscopy in dogs permits detailed intra-articular visualization. the arthroscopic and instrumental portals were simple to be done.
Arthroscopic Surgery of the Elbow; Indications, Contra-Indications, Complications and Operative Technique  [PDF]
Frank Theodoor Gabriel Rahusen, Orthopedic Surgeon, Denise Eygendaal
Surgical Science (SS) , 2011, DOI: 10.4236/ss.2011.25049
Abstract: Arthroscopy of the elbow was first described by Burman in 1931. In this first article about arthroscopy of the elbow in the journal of bone and joint surgery, he concluded that the elbow joint was not suitable for arthroscopy; the joint was too small and the neurovascular structures in the anterior compartment of the elbow were close. In 1932 he revised his original article with some technical modifications and slowly arthroscopy of the elbow was performed more often. In the late 1980’s arthroscopic surgery of the elbow became more and more popular. In this article an overview is given of the indications for elbow arthroscopy, the surgical technique is described in detail and the possible complications are highlighted.
ARTHROSCOPIC VERSUS OPEN STABILIZATION FOR TRAUMATIC ANTERIOR SHOULDER INSTABILITY: A COMPARISON OF CLINICAL OUTCOMES  [PDF]
Kyung HS,Micic ID,Jeon IH
Acta Facultatis Medicae Naissensis , 2006,
Abstract: With the advance of arthroscopic surgical technique and instruments, minimal invasive arthroscopic reconstruction has become preferred treatment method for Bankart reconstruction. The aim of this study was to describe surgical technique and report the results after either open or arthroscopic Bankart shoulder stabilization in a retrospective series with a medium-term follow-up. We performed a retrospective study comprising 43 patients (43 shoulders) with symptomatic, traumatic anterior shoulder instability to compare open versus arthroscopic reconstruction. Twenty eight arthroscopic reconstructions and fifteen open reconstructions were performed using metal suture anchors. All of the patients had the Bankart lesion. Independent observers examined the shoulders at a median follow-up period of 41.1 months (range, 16 to 57) for the arthroscopic group and 68.1 months (range, 51 to 113) for the open group. The recurrence rate was two of 15 (13%) in the open group and 7.1% (2 out of 28) in the arthroscopic group. During the follow-up, the Rowe score was 84.3 points (range, 39 to 100) in the open group compared with 87.3 points (range, 53 to 100 for the Rowe scores, respectively) in the arthroscopic group. Both methods produced stable and well-functioning shoulders in the most of patients with the Bankart lesion. Although the arthroscopic technique can lead to a higher recurrence rate, better results were attained for external rotation of the shoulder in the patients treated with this minimally invasive technique.
Elbow Arthroscopy: Review of the Literature and Case Reports
Prakash Khanchandani
Case Reports in Orthopedics , 2012, DOI: 10.1155/2012/478214
Abstract: Elbow arthroscopy, though described first in 1930s, gained popularity only in the last 3 decades. There has been a steady expansion in the clinical applications of elbow arthroscopy owing to the significant improvements in instrumentation and arthroscopic skills. The procedure which was mainly used for diagnostic purpose, loose body removals, and synovial biopsy has now become an important tool for managing elbow arthritis, stiff elbow, and trauma. However, this procedure has a higher incidence of neurological complications and hence case selection and surgeon’s expertise are of utmost importance.
Analysis of results of surgical treatment of posttraumatic stiff elbow  [cached]
Rex Chandrabose,Suresh Kumar P,Srimannarayana Addagalla,Chugh S
Indian Journal of Orthopaedics , 2008,
Abstract: Background: Surgical management of posttraumatic elbow stiffness has been reported with poor outcome following treatment. Sequential release in earlier stages of stiffness yielded much better results. The goal of our study was to assess the outcome in improvement of the range of motion of the elbow after surgical release and to analyze a tailor-made approach according to individual needs to yield good result. Materials and Methods: A prospective study was conducted in 47 cases of elbow stiffness due to various types of injuries. All the cases were treated with sequential release if there was no progress after adequate supervised conservative management except in unreduced dislocations. All the cases were followed up for a minimum period of 24 months. Overall outcome was rated with the functional scoring system by Mayo Clinic Performance Index. Results: Twenty-five (44.68%) out of 47 patients had excellent results with a mean preoperative range of motion of 33.9° and postoperative range of motion of 105° with net gain in range of motion of 71.1° (′ t ′ test value is 19.27, P < 0.01). None of the patients had elbow instability. Patients not having heterotopic ossification, who underwent surgery from three to six months post injury had a mean gain of 73.5°. In patients who waited for more than six months had mean gain of 66.8°. However, the results in cases having heterotopic ossification followed a slightly different pattern. In cases where release was performed from three months to six months had mean gain of 77.5°. Cases in which release was performed after six months had gain of 57.1°. Conclusions: In cases of posttraumatic elbow stiffness after a failed initial conservative treatment, early arthrolysis with sequential surgical soft tissue release yields good result than delayed surgery.
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