When people experience chronic elbow pain, right solution may be much closer than they think it is. Orthopedic surgeons perform elbow surgery so as to treat conditions which include inflammation & degeneration of tendons attaching elbow joints (tennis elbow), fractured or broken elbows, arthritis of elbows from both wear & tear & rheumatoid arthritis, nerve pain in elbow (cubital tunnel syndrome) & throwing injuries.
Time is ripe to look for elbow surgery when rest, therapeutic exercise, ultrasound & medications have failed to reduce inflammation in elbow joints. Orthopedic surgeons in such conditions can help decide whether surgery is the right option & which type of procedure will provide the best outcome. These surgeons can effectively perform minimally invasive arthroscopic surgery or open traditional elbow surgery so as to repair fractures & resurface elbow joints using biologic tissue. Moreover, partial or complete elbow replacement can be the best alternative option for some conditions. Orthopedic surgeons can also repair or reconstruct ligaments or perform surgery to remove pressure from nerves for cubital tunnel syndrome patients.
Tennis elbow is basically inflammation of muscle tendon located on the outside of elbow. Lateral Epicondylitis is the medical term for tennis elbow. This inflammation is eventually caused by repeated strain of muscle known as Extensor Carpi Radialis Brevis or ECRB in short. Contrary to popular belief, this condition is not specific to tennis players & can almost affect anyone whose working may strain ECRB, like such people who undertake exercise or manual labor.
Elbow surgery is a challenging task. Not just because elbow is a relatively small & complex hinge joint, but also due to the reason that next-generation arthritis medications have created healthier patients who require more durable & longer lasting treatments including elbow joint replacement surgery. Normally, surgical options for elbow treatments are only considered when medications & other measures are unable to relieve severe pain in joint & loss of motion. Following is an overview of some common types of elbow surgeries. These can either be performed arthroscopically by using small incisions along with fiber-optic camera technologically or through an open conventional operating procedure.
It is important that patients remove all jewelry from the affected arm in preparation for ECRB release surgery. They will also need to fast (including eating & drinking) from midnight on the day prior to undergoing surgery. Pre-assessment team will sit with the patient & discuss as to which medications (in case the patient is taking) can be taken on the day of surgery. They will also provide patients with more information regarding preoperative preparations. While asking for consent, the healthcare team will invariably involve patients in all decisions about aftercare & treatment. Patients will also be asked to sign a consent form in case they will like to go ahead with the surgical procedure. This will eventually confirm that the patient has agreed to undergo the procedure after having understood all that is involved.
Patients will be examined by the doctors of the surgical team on the day of admission, & they will mark the site of surgery & ask them to sign the consent form in case this has not already been done. Anesthetists will then review fitness for surgery & finalize the planned anesthetic regimen. The patient will be now taken to the operation theatre for the procedure to be performed under the influence of general anesthesia. Surgical procedure involves making several small incisions around the elbow so as to enable the arthroscope access the elbow joint. Following locating & accessing the ECRB muscle, the orthopedic surgeon will then eventually cut the tendon. After completion of this operation, incision sites will be stitched & dressed with sterile dressings. Patients are also given slings after completion of the procedure.
Postoperative pain is quite normal & patients will most probably receive a combination of pain-relieving medications so as to minimize pain. Patients will also be transferred to the recovery room following operation & where they will initially be closely monitored for any complications. After the observation period they will either be transferred to the orthopedic ward or ambulatory care unit. Most patients are allowed to go home on the day of surgery while some require an overnight stay at the hospital. Time for discharge from hospital will however depend upon individual circumstances & which will also be discussed with the patient before the procedure. However, patients will require someone who can drive them back home & for someone to stay with them in case they are staying overnight at the hospital facility. Patients may also be seen by an orthopedic physiotherapist in case the surgeon indicates that this is needed.
Elbow will usually feel stiff for the first few days after patients get home following the surgical intervention. However, this gradually improves over time. It is important for the patient to continue with the physiotherapy exercise at home in case they were given, so as to avoid risk of stiffness remaining in elbows & which will eventually reduce potential benefits that were meant to be obtained from this surgical procedure. It is also very important that patients regularly move their fingers, wrist & shoulder in order to prevent these joints from stiffening up. While leaving the dressing intact, patients must clean up & dry the area until the next follow-up appointment & which is usually about 15 days following the elbow operation. Since it is extremely essential that patients relax & maintain adequate levels of pain relief after surgery for normal recovery, they must make sure that they regularly take the prescribed painkillers. They should also seek further advice of the doctor in case they are still in pain. Patients may sign-off from work for about 1 – 3 weeks of time depending upon the nature of their work.
Follow-up appointments after elbow surgery are usually conducted after two weeks & will require the patient to visit the outpatient department of the hospital & have their wounds checked & stitches removed. Dressings are also checked during this appointment & are reduced as appropriate in each case. Patients will also be reviewed by orthopedic doctors during this follow-up appointment.
Need for elbow surgery is however dependent on the amount of discomfort & disability the patient is suffering as a result of his/her condition. Elbow surgery is just one possible treatment for this type of condition. Other alternative treatment options for elbow problems include physiotherapy, use of a counter-force brace or steroid injections of the tendon. These could be initially tried so as to help improve range of movement. Moreover, orthopedic doctors usually discuss these options with patients before they commit to surgery.
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