Types of operations on the elbow joint, methods of treatment and recovery

If we take the total number of orthopedists, approximately 70% of them specialize in knee and hip joints. 20% on the shoulder joints, and the remaining 10% on the elbows. That is, there are very few specialists who can not only pump out fluid from the cavity of the joint capsule, but also carry out the most complex surgical intervention. To find an expert with experience you need to try. We have such specialists in our arsenal, and as practice shows, their opinions and methods of treatment are positively assessed throughout the medical community.

A number of problems of the elbow joint, injuries and some diseases in the later stages are treated exclusively with surgery. There are several such treatment methods:

• Arthroplasty;
• Open repository;
• Stitching of ligaments;
• Endoprosthetics;
• Transposition.

There are two more types that relate to both therapeutic and diagnostic, one of them is puncture, i.e. fluid sampling, and the second arthroscopy - instrumental examination from the inside.

Arthroplasty

Similar effects are often carried out at the joints of the ends of bones. They represent the modeling of the joint to natural forms. If the patient complies with all the requirements of the rehabilitation medicine doctor, then the probability of a positive outcome is almost 100%.

The result of the operation on x-ray.

Indications are fibrous and bone ankylosis. With this deviation, the joint partially or completely loses mobility due to pathological changes. The causes of destruction are often arthritis, trauma, and arthrosis. With multiple fragmentations of the elements included in the connection, reconstruction becomes impossible. In this case, the fragments are removed, and the missing part is filled with artificial or the patient’s own tissues.

The elbow joint is able to move normally and function only if all its components have natural sizes and shapes. The technique is aimed at performing precisely this task. Today they produce ready-made plates that cover the surface of the affected joint. They are made from medical alloys or polymers. Special pastes and mixtures are also used to coat the compound. These products penetrate into the pores and gaps and harden there.

Sports injuries of the elbow joint[edit | edit code]

The structure of the elbow joint
For athletes involved in powerlifting and bodybuilding, the elbow joints are the most vulnerable place. The predisposition to injuries of this kind is explained by the specifics of these sports. Despite certain differences, both powerlifting and bodybuilding are based on a set of strength exercises that place increased stress on the musculoskeletal system of the elbow joints.

The assessment of the skill of powerlifters is based on three main demonstration exercises:

• squatting in the “barbell on the shoulders” position;
• barbell row in the “from the floor” position (deadlift);
• lifting the barbell from the bench in a horizontal position “lying on your back” (bench press).

All of them are equally dangerous, since the main load during their execution is directed to the shoulder joints and elbows.

In bodybuilding, an elbow injury can be caused by long-term regular exercises performed along an unnatural trajectory. This usually includes:

• bench press from behind the head in a standing position (French press);
• French press, performed in a prone position;
• wide, versatile arm raises using heavy dumbbells;
• push-ups with deep amplitude, performed on uneven bars (push-ups on uneven bars).

In such situations, not only beginners, but also experienced athletes can be the injured party. For beginners, the cause of elbow injury is most often sudden movements, unreasonable weight loads and ignorance of the basic rules of exercise technique. Those who are experienced in practice often pay the price for ignoring age-related changes in the elbow joints, thereby exceeding the maximum permissible load norms for their age.

Reposition

Schematic representation of the procedure.

For fractures and dislocations, when it is impossible to set or restore the bone, reposition is performed. The operation is an internal restoration of the structure of the joint. To do this, an incision is made along the back surface of the extensor part of the arm, exposing the bones and their joints. Transverse channels are made on the fragment and on the inner surface. All components are assembled in their original position, a spoke is placed along it, which is secured with screws in the made channels. Tendon fibers, which are taken from the lateral sections of the triceps, wire, and other materials, can also be used as fastening. Fasteners are selected depending on the location of the fracture. The attachment process is called “osteosynthesis”. If the tendons were damaged during crushing, their restoration is carried out simultaneously with reposition.

How is the joint structured?

A joint is a movable joint between two bones. It is needed in order to redistribute the load on the limbs. The ends of the bones or epiphyses are congruent to each other: where there is a bulge on one bone, there is a depression on the other. The epiphyses are covered with hyaline cartilage. The joint is surrounded by a dense fibrous membrane. The cavity is filled with synovial viscous fluid having high viscosity. The joint receives nutrition from this fluid. There are ligaments around the joint that strengthen it on all sides. The movements performed in the joint are strictly defined - flexion-extension, adduction-abduction, rotation and rotation.

For joint health, their correct geometry is incredibly important. At the slightest violation - a ligament tear, a displacement of the articular surfaces invisible to the eye - the remaining parts of the joint receive chronic overload, and their wear accelerates many times over. The reasons for this are manifold: microtraumas, monotonous daily loads, athletic jerks or excessive physical activity. If the joint is left untreated, the biomechanics and structure of the intra-articular cartilage are irreversibly altered. To stabilize the joint, the body grows osteophytes, or bony spurs, that change the joint so much that movement may become impossible.

Ligament restoration

Damage to this element is quite rare and relates more to sports. They can be partial or complete. In the first option, the entire course is treated with conservative methods and lasts for 2-3 weeks. During this period, the patient's limb is immobilized.

Elbow ligament injury

In case of a complete rupture, manipulations to fuse the ligaments are necessary. To do this, an incision is made on the back of the elbow, and the connective tissue is sutured in small sections.

Knee

Knee joint injury is the most common and varied in its manifestations. Everything can happen: from a simple bruise to intra-articular fractures, dislocations and meniscus tears. The joint is a large one, bears the weight of the entire body, and experiences constant stress. Three bones connect here: the femur, tibia and patella. There are five synovial bursae and three types of ligaments: lateral, posterior and intra-articular, the largest of which are cruciate.

The most severe cases are ruptures of the cruciate ligaments, fractures of the condyles or spherical ends, and damage to the meniscus.

The knee has a unique structure, and traumatologists always try to preserve tissue as much as possible. Thus, torn ligaments are replaced with synthetic tape, only small fragments are removed, and large fragments are fixed with metal, the meniscus is only partially removed.

Endoprosthetics

This technique is one of the most complex and at the same time effective. With its help, you can restore your limbs to their former mobility. Its essence is to replace a damaged part of the skeleton that cannot be restored or treated with an endoprosthesis made of neutral materials. Indications for this procedure are:

• Arthrosis and arthritis;
• Comminuted fractures;
• Ankylosing spondylitis;
• Dystrophic and atrophic processes;
• Dysplasia;
• False joint.

The prosthesis is implanted through an incision on the extensor side, fixed with cement or cementless and sutured. The rehabilitation period is 2-3 months, but movements of the replaced part are allowed within a month after suturing.

Common Elbow Injuries

Elbow joint injury is one of the most difficult. A neurovascular bundle runs near the joint, which is almost always damaged. Associated neuritis significantly complicates the course of the injury - this is additional pain, impaired trophism, developing contractures or immobility. In addition, the elbow joint does not respond well to physical therapy and this method is not used, which prolongs the recovery time.

The olecranon often breaks off and cannot be put back into place without surgery. Such a fracture can be successfully treated only with the help of metal osteosynthesis, when the fragment is attached to the ulna with a metal structure. The prognosis in this case is favorable, movements return in full after recovery.

The prognosis for complete recovery is less guaranteed for comminuted fractures, especially intra-articular ones. An open access operation is performed when those fragments that are unlikely to grow are removed. The prognosis depends on how much bone tissue had to be removed. The use of alloplants is sometimes possible, sometimes not - it all depends on the clinical picture and the general level of health of the patient.

Traumatologists consider elbow injuries to be the most “fastidious”; complications can arise at any stage.

Transposition

It is performed for carpal tunnel syndrome. The disease develops due to increased pressure on the nerve passing through the elbow joint. It often occurs after bruises and is felt almost instantly: pain radiates to the forearm and hand, numbness appears on the inside of the limb and on the fingers. The pain intensifies when bending the elbow.

Pathology is diagnosed by palpation - a specialist finds pain points and determines the location of the damage. To confirm, electromyography and electroneuromyography can be performed, which examines the rate of arrival of nerve impulses. With carpal tunnel syndrome, the transmission rate is significantly reduced.

Treatment of the disease is permitted conservatively. In many cases, it is enough for the patient to exclude movements that cause him pain. If this is difficult, then it is possible to apply a special splint. If this method does not help, then transposition is performed.

This procedure involves moving the nerve to the front of the junction. This will avoid tension on the nerve and pain. To perform this, an incision is made in the area of ​​the epicondyle, the nerve is removed from the articular canal and laid along the front side of the joint. Such operations are performed extremely rarely and only in situations where it is impossible to eliminate the disease by non-traumatic methods.

Ankle joint

Ankle joint injury is the most common, especially in winter when there is ice, as well as among athletes, skiers and lovers of high-heeled shoes.

Most often, ligaments are torn, followed by fractures. The vulnerable spot is the ankles or lateral processes of the tibia, forming the “fork” of the joint. This joint transfers the full weight of the human body to the foot. Based on the number of broken processes, one-, two- and three-malleolar fractures are distinguished, when the edge of the tibia is also broken.

A fracture may be accompanied by dislocation, subluxation and displacement of fragments. Such fractures are often treated conservatively, but there is a pattern: it takes at least four weeks for one ankle to heal.

You should consult a doctor immediately after a fall, jerk, or joint pain. It is impossible to determine “by eye” what exactly happened in the joint. If a fracture occurs, the strong leg muscles literally “pull” the fragments in different directions, and over time it is very difficult, and sometimes impossible, to reconcile them. What could have been corrected yesterday by applying a splint, today has to be treated surgically.

Traumatologists at the CELT clinic are always ready to quickly come to the rescue. The clinic has unique medical equipment for monitoring the geometry of joints and the position of limbs. You need to understand that a tiny shift in one place inevitably entails changes throughout the entire body. The bones, muscles and ligaments adjacent to the damaged joint adapt to what is there and change too. If you put off visiting a doctor for too long, you can develop arthrosis and many other troubles.

Diagnosis and treatment

There are two diagnostic methods that are also used for therapeutic purposes: puncture and arthroscopy.

Arthroscopy allows tissue examination without resorting to large incisions. To perform this procedure, a few small ones are enough, through which the arthroscope and instruments are inserted into the cavity. With such penetration, the specialist has the opportunity not only to study the condition of the patient’s bone and muscle materials, but also to remove damaged cartilaginous structures, inflamed synovial structures, restore cartilage, etc. Such targeted effects can shorten the rehabilitation period and reduce the area of ​​damage to the integumentary tissue.

Indications:

• Cartilage lesions;
• Arthrosis;
• The presence of foreign bodies or fragments of bones and cartilage;
• Inflammation;
• Ligament ruptures;
• Arthritis;
• Joint instability.

The puncture is used to collect biomaterial for further research. This option may also be suitable for administering medications directly to the lesion site. At the same time, depending on the purpose of the procedure, tools are selected. If the process is performed for the sole purpose of research, then a syringe is used with a thick needle. It can reach 2 mm in diameter. This is necessary to prevent clogging of the needle tunnel with small particles. A thinner needle is used to administer drugs.

The puncture is performed in the following situations:

• Accumulation of lubricating fluid in the cavity;
• Collection of blood;
• Arthrosis;
• Degenerative processes;
• Inflammatory diseases.

Iron Health

For athletes actively involved in bodybuilding and strength sports, the elbow joints are a very vulnerable place to injury. The predisposition to such injuries is explained by the specifics of these sports. Despite some significant differences, bodybuilding and powerlifting are based on heavy compound exercises that place increased stress on the musculoskeletal system of the elbow joints.

If you take the main powerlifting exercises - the squat, bench press and deadlift - they all put equal amounts of stress on the shoulder and elbow joints.

In bodybuilding, elbow injuries can be caused by using exercises for a long time that are not entirely natural. Such movements include:

• French press standing
• French bench press
• Dumbbell flyes using heavy weights
• Dips with deep amplitude.

It must be said that not only beginner athletes, but also athletes with extensive training experience are susceptible to injuries to the elbow joints. For beginners, as a rule, such injuries are caused by sudden movements of exercises, the use of excessive weight, as well as serious violations of the technique.

Experienced athletes often suffer from elbow injuries due to exceeding the permissible load on the joints, which, under the influence of age-related changes, lose their strength qualities.

Symptoms of an Elbow Injury

The elbow joint has a complex structure that makes it both strong and very vulnerable at the same time. This joint is a connection between the shoulder bone and the radius and ulna bones of the forearm. The peculiarity of the structure of the elbow joint is that there is a large volume of cartilage tissue, the nutrition of which is slow. This is explained by the fact that there are no blood vessels in these tissues, so synovial fluid acts as the main transport of nutrients. It is clear that constant excessive stress on the elbow can lead to negative changes. Moreover, these changes are often irreversible, in particular, the development of severe arthritis

Beginning problems with the elbows do not manifest themselves quickly and like an avalanche - pathological changes in the elbow joint accumulate over the years. The first signs of injury may be slight pain and a decrease in the amplitude of exercises during training.

In general, there are two forms of elbow disease:

• Epicondylitis
• Tendinitis

In the first case, there is acute pain in the elbow, which intensifies when you try to squeeze your hand or hold any object in it. The cause of pain here is inflammation of the ligaments, which develops with a decrease in metabolic processes. There are no external changes in the elbow. This disease most often occurs in athletes over 30 years of age.

Elbow tendinitis is an inflammation of the tendon tissue. Most often, this disease occurs with constant excessive load on the elbow joint. Painful sensations actively manifest themselves when moving and palpating the tendon area. In addition, any movements are accompanied by a crunching sound. Prevention and treatment methods

The very first step in treating an injured elbow joint is to ensure complete rest. Sometimes doctors advise temporarily immobilizing the elbow by applying a light plaster cast.

For inflammation of the joints, the drug Ibuprofen helps well, as it reduces inflammation and also has an analgesic effect. This medicine is available both in the form of tablets and ointments (gels).

If there is no positive result for a long time, injections of antibiotics and corticosteroids are used in treatment. Currently, the most progressive methods of treating such injuries are laser exposure and shock wave therapy.

It should be noted that even during an injury, doctors do not advise completely giving up physical activity. Light physical exercise will be very useful and indispensable for the speedy functional recovery of the elbow joint.

Athletes who have suffered from similar injuries in the past need to structure their training programs to avoid excessive stress on their elbows. In this case, you should exercise in elbow bandages, which will provide the necessary compression support to the joints.

Main methods of treatment

Treatment of injury is mainly conservative. In the first few days, it is important to fix the elbow in a half-bent and slightly raised position so that fluid does not accumulate in the subcutaneous tissues. You can also apply ice and cold compresses.

In the future, the doctor may recommend wearing a rigid removable splint. It is worn for a day, but is periodically removed to develop muscles and ligaments. Unlike a plaster cast, it can also be used for open wounds in the elbow area.

The main treatment regimen is the use of drugs for external use in the form of ointment, cream or gel.

They are selected according to indications and may contain different active ingredients. To treat sprains, the following groups of medications are prescribed:

• non-steroidal anti-inflammatory drugs (Diclofenac, Nurofen-gel, Dolgit, Nise and others);
• irritating and warming ointments (Finalgon, Apizartron, Capsicam);
• chondroprotectors (Chondroitin sulfate, Teraflex).

The operation is performed only in case of complete rupture of the ligament, as well as when it is separated from the bone. Surgery occurs under local anesthesia, and the recovery period can take several months. Healing takes place under a tight bandage.

Orthopedics and traumatology services at CELT

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