Operative Techniques

Elbow arthroscopy has made open resection of olecranon osteophytes primarily a point of historic interest. However, occasions still exist when an open procedure may and should be performed. The determining factor in this decision should be whether a contraindication to elbow arthroscopy is present. If a contraindication is present, the posterior compartment may be accessed through an open posteromedial or open posterolateral approach. The decision as to which approach is used should be based on the nature or existence of concomitant elbow abnormalities.

The posteromedial approach to the elbow is used when concomitant UCL reconstruction, ulnar nerve transposition, or exploration of a previously transposed ulnar nerve is to be accomplished in conjunction with removal of pos-teromedial osteophytes. The surgeon places the patient supine. The shoulder is abducted 90° and externally rotated on a hand table. The medial antebrachial cutaneous nerve always should be identified and preserved. The ul-nar nerve always is protected and mobilized, and vessel loops are placed both proximally and distally. If UCL reconstruction is necessary, posterior compartment lesions should be addressed before reconstruction. Usually, exploration of the ligament is done, and then attention is turned to the posterior compartment. A small capsular incision just proximal to the posterior band of the UCL is made, and the posteromedial olecranon and medial aspect of the trochlea and olecranon fossa are identified and inspected. If an osteophyte is present, a ^-in. osteotome is used to resect the proximal 1 cm of the olecranon and the medial osteophyte. The debridement should be completed with a rongeur to smooth the resected edges. The medial aspect of the distal humerus should be inspected, and any chondromalacia should be smoothed out. Before closure, the joint should be irrigated thoroughly.

Before the advent of elbow arthroscopy, the open pos-terolateral elbow approach was used to treat VEO. It still may be employed if concomitant radiocapitellar chon-dromalacia must be addressed and arthroscopy is con-traindicated. Additionally, in the absence of abnormality in the medial aspect of the elbow, a posterolateral approach avoids mobilization of the ulnar nerve. To begin this approach, the surgeon makes a straight incision that is centered over the lateral supracondylar ridge of the humerus. This incision is extended 4 to 5 cm distally. Dissection through the edge of the triceps tendon and the anconeus is done sharply, and these fibers are elevated from the supracondylar ridge. Retraction of the triceps

FIGURE 10.4. Broken lines indicate posteromedial olecranon lesion and area that is removed surgically. (Adapted from Wilson FD, Andrews JR, and Blackburn TA, et al.14)

FIGURE 10.4. Broken lines indicate posteromedial olecranon lesion and area that is removed surgically. (Adapted from Wilson FD, Andrews JR, and Blackburn TA, et al.14)

exposes the posterior compartment. Additional dissection of overlying synovial tissue may be required to fully expose the proximal tip of the olecranon. Flexion and extension of the elbow further aid in visualization. After the exposure is adequate and the lesion is identified, the ^-in. osteotome is used to resect the osteophytes in the same fashion as described for the posteromedial approach (Fig. 10.4). This approach requires additional caution because the ulnar nerve lies within close proximity to the osteotome or the biting end of the rongeur when the medial osteophyte is debrided from this angle. As with the posteromedial approach, the surgeon smoothes the resected edges with a rongeur and irrigates the joint. Closure is done in a typical fashion.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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