An arthrotomy is any surgical procedure that requires opening a joint. In the case of the elbow, arthrotomy is performed to relieve the persistent symptoms and pain resulting from a condition such as tennis elbow.
Tennis elbow, also known as lateral epicondylitis, is an elbow injury that occurs as a result of overuse, most commonly from playing tennis or other activities with similar repetitive motions. The pain associated with this condition affects the lateral epicondyle, the area where the forearms’ tendons connect with the bony outer portion of the elbow. While tennis elbow typically occurs in adults aged 30 to 50, anyone who continually stresses their wrists is at a higher risk of developing this condition.
The symptoms of tennis elbow affect the inside of the elbow, and may include some of the following:
- Forearm weakness
- Pain when the wrist is extended
- Pain during various activities, such as turning a doorknob
- Pain that spreads from the outside of the elbow into the forearm and wrist
In many cases, tennis elbow can be managed with rest, ice and over-the-counter painkillers. Severe, non-responsive cases of tennis elbow may require surgery; however, surgery is only necessary for about ten percent of those suffering from tennis elbow.
Arthrotomy is a traditional, open surgery in which the doctor has a full view of the elbow joint. Anesthesia is required for this procedure and may be either general or regional. The surgeon makes an incision over the elbow and examines the joint. Depending upon the exact nature of the problem causing the patient’s pain, there are several possible ways that your doctor may resolve the condition once the elbow is open for examination.
Often, the symptoms are the result of an issue such as tiny tears in the extensor carpi radialis brevis tendon. Relief may be accomplished through a tendon release, in which the doctor debrides the degenerative and painful sections. This creates more room for the healthy parts of the tendon to loosen up and have improved function. The tendon may be cut into to relieve some of the stress that has been placed on it, and any swollen or damaged tissue will be removed.
If tears are present in the tendon, they may be repaired or reattached as long as that will not result in creating too much tightening within the tendon. In some cases, the tendon will be anchored to the bone by sutures. The surgeon may also need to make tiny holes in the surface of the bone in order to use underlying layers to stimulate healing.
At times, fragments of bone or cartilage are found in the elbow joint. If that has occurred, the surgeon will carefully remove any of these fragments that can cause inflammation and pain. Any existing bone spurs at the site will be shaved down as well to reduce irritation.
Risks of Arthrotomy
While arthrotomy is generally considered a safe procedure, all forms of surgery pose some risk. In addition to the potential complications of any type of surgery such as infection, nerve damage, bleeding and anesthesia problems, possible arthrotomy risks include elbow stiffness or loss of mobility, blood vessel damage and loss of strength as well as prolonged or ongoing pain around the joint.
Recovery from Arthrotomy
The recovery period for this procedure varies depending on each particular patient’s condition. Arthrotomy is typically an outpatient surgery, but occasionally a patient will be admitted to the hospital for one night. A splint is usually required for the first week after surgery to keep the arm immobilized and promote healing. Ice and anti-inflammatory medication should be used as necessary. Most people achieve a full recovery in three to six months after the arthrotomy.
Physical therapy is a vital component to a complete recovery, helping to strengthen the muscles and tendons around the elbow and regain a normal range of motion for the joint. Therapy generally begins with a series of light exercises to regain mobility and progresses to a full regimen after several weeks.
When post-surgical instructions from your doctor are adhered to and a commitment to regular physical therapy is made, the success rate of arthrotomy is very high. Most patients can resume their typical athletic activities within four to six months after the procedure, although there may be limitations to the repetitive activities that most likely caused the pain in the first place.