Elbow Surgery | Specialists and Information

The elbow, or elbow joint, is one of the most complex joints in the human body. It consists of three joints involved in the movement and rotation of the forearm:

1. Humeroulnar joint (joint between the humerus and the ulna): serves to flex and extend the forearm,
2. Radioulnar joint (joint between the radius and the ulna)
3. Humeroradial joint (between the humerus and the radius): enables rotation of the forearm

The elbow joint is surrounded by a joint capsule. Several ligaments stabilize it. A layer of cartilage at the ends of the bones protects them from wear and tear. The bursae also serve to protect the joints from excessive strain.

Several upper arm muscles are involved in the movement of the forearm. They are connected to the forearm bones via tendons that pass over the elbow joint.

Anatomy of the Elbow @ bilderzwerg /AdobeStock

Various injuries can occur in the elbow region, such as:

• Bone breaks (fractures)
• Torn ligaments
• Bone avulsions or
• Dislocations

In medical terms, a dislocation refers to a bone suddenly popping out of its natural position. This usually occurs as a result of a fall or other external force. A fracture of the radial head is the most common fracture in the elbow region.

With any injury, there is always a risk of damage to blood vessels and nerves.

In addition to the injuries mentioned above, elbow surgery specialists also treat the following conditions:

Tennis elbow: Also known as epicondylitis humeri, it results from regular overuse of the muscles. This leads to inflammation of the muscle attachments on the outside of the elbow. This can occur in certain sports (such as tennis) or during manual labor.

Tennis elbow is characterized by pain on the outside of the elbow that radiates into the forearm and upper arm.

With tennis elbow, the muscle tendons on the outer side of the elbow are painful @ GraphicsRF /AdobeStock

If the muscle insertions on the inner side of the elbow are irritated, the condition is referred to as golfer’s elbow (pitcher’s elbow, epicondylitis humeri ulnaris).

Ulnar tunnel syndrome (cubital tunnel syndrome) involves functional impairment of the hand and fingers, leading to reduced or restricted mobility. This is caused by chronic irritation of the ulnar nerve (nervus ulnaris). It is classified as a nerve entrapment syndrome.

Congenital malformation of the elbow: In radioulnar synostosis, the ulna and radius are fused together. In congenital radial head dislocation, the radial head is permanently dislocated.

Elbow osteoarthritis: This condition involves excessive wear and tear of bone and cartilage, as seen in rheumatoid arthritis.

In addition to asking the patient about their symptoms (such as pain, sensory disturbances, and functional limitations), the clinical examination is the primary focus.

During this examination, the physician palpates the elbow joint and adjacent structures. They look for misalignments and swelling, as well as changes in skin color. They also assess the range of motion of the arm and hand (functional tests). 

This provides initial indications of whether a dislocation is present and whether nerves and blood vessels are affected.

If a bone fracture is suspected, or to rule out fractures, and in cases of elbow dislocation, an X-ray examination is performed. 

X-rays provide a very clear view of the bones. An even more detailed view of the bony structures can be obtained with computed tomography (CT). Bleeding, bruising, or swelling are also visible this way. CT is also used in cases of complex elbow dislocations. 

Magnetic resonance imaging (MRI) is more commonly used for injuries to ligaments and soft tissues, as well as to muscles and bursae.

However, ultrasound (sonography) is also effective for visualizing soft tissue structures. Therefore, it is used for bursitis, joint effusions, and bruises, as well as for injuries to muscles and tendons.

Bursitis of the elbow usually manifests as swelling on the back of the joint @ Praewphan /AdobeStock

High-resolution ultrasound machines can even visualize nerves. If a nerve entrapment syndrome is suspected, a neurological examination is performed to measure nerve conduction velocity.

In some cases, the doctor uses arthroscopy (joint endoscopy) to get a detailed view of the inside of the joint.

During this minimally invasive procedure, the doctor can also perform therapeutic interventions right away, such as the removal of bony structures.

The treatment methods used by elbow surgery specialists include:

• Arthroscopies (joint endoscopy) 
• Minimally invasive procedures 
• Open surgeries

There are surgeries to stabilize the elbow joint and to treat injuries and fractures. Osteosynthesis, for example, is a surgical procedure to connect individual bones or bone fragments so that they can heal together again.

Elbow surgery also includes the correction of congenital deformities, joint replacement surgeries, and the treatment of certain conditions.

The range of services provided by an elbow surgeon includes, among other things:

• Treatment of tennis elbow
• Treatment of golfer’s elbow
• Treatment of nerve entrapment syndromes
• Removal of osteophytes (abnormal bony growths at the edge of the bone)
• Removal of loose bodies
• Treatment of Elbow Osteoarthritis
• Treatment of bursitis
• Removal of the synovial membrane in rheumatoid arthritis (synovectomy)
• Treatment of limited range of motion and joint stiffness
• Treatment of bone fractures and multiple ligament tears; depending on the severity, the joint may need to be stabilized with plates and screws.
• Reduction of a dislocated bone