Arthrofibrosis (stiff joint) is a common reason people come to see Dr Shepard. Using four to six poke holes in the skin and a combination of cameras (2.7 mm, 4.5mm), Dr Shepard will remove the loose bodies, bone spurs, and the contracted capsule (casing) that restrict the elbows range of motion. Less than 10% of Orthopaedic Surgeons perform elbow arthroscopy and even fewer perform arthroscopic releases. An arthroscopic release caries several advantages over traditional open releases: less pain, quicker recovery, better final range of motion.
This patient presented with severe loss of motion - her range of motion was 30-95 degrees, whereas normal motion is 0 (straight) to 145 (bent) degrees. Picture 1 shows the scarred anterior capsule, which was restricting extension. Pictures 2, 3 and videos 1,2 show the anterior capsule being resected. Picture 4 shows the removal of a loose body that was causing irritation and pain. Pictures 5,6 and video 3 show resection of the olecranon tip / bone spurs and the resection of the posterior capsule. Final motion achieved with the release was 0-135.
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Video 1
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How is elbow arthroscopy different than other surgeries?
Elbow arthroscopy is not as common a procedure as arthroscopy of the knee and shoulder. According to the American Academy of Orthopaedic Surgeons Survey, less than 10% of orthopaedic surgeons perform elbow arthroscopy. Elbow arthroscopy is technically demanding, requires multiple portals, utilizes multiple cameras, and should be performed with someone with a strong background in the surgery. Dr Shepard learned elbow arthroscopy from world famous James R Andrews MD – one of the developers and forefathers of the technique in the United States. Dr Shepard has performed elbow arthroscopy on high level overhead athletes from UC Irvine, Cal State Fullerton, and Chapman Universities.
Who needs elbow arthroscopy?
There are two primary groups of people who undergo elbow arthroscopy – young overhead athletes with loose bodies and OCD lesions; older people with loss of motion (arthrofibrosis).
The young athletes often develop loose bodies or cartilage lesions from their repetitive injuries. These lesions can be treated through the arthroscope with loose body removal and cartilage restoration techniques. These injuries are most commonly seen in baseball and softball athletes, as well as young athletes who compete in gymnastics, wrestling, and weight lifting.
The older athlete who looses motion, also known as arthrofibrosis, can be treated through the arthroscope as well. These patients loose the function of their elbow as their motion decreases over time. This problem can be treated with an arthroscopic release of scar tissue and capsule to restore motion. Sometimes, a small burr will be used to resect bone spurs to restore motion.
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