Elbow Impingement Surgery

What is it?

Elbow impingement surgery is needed when there is compression and injury of soft tissue structures, such as cartilage, at the back of the elbow or within the elbow joint. It is caused by repetitive forced extensions and overuse of the elbow. It can either occur in isolation or in athletes in overhead-throwing sports like baseball, football, volleyball, and tennis.

Anatomy

It is caused by repetitive hyperextension. Over time this causes inflammation of the joint lining and, later, damage to the cartilage and the formation of bony spurs. These bone spurs then exacerbate the problem.

Indications and symptoms

The typical symptoms are pain and tenderness at the back of the elbow, especially when trying to throw or straighten the elbow. This may lead to locking and catching. There may be swelling of the elbow and stiffness. Toward the late stages, an inability to fully straighten the elbow.

Procedure

Impingement syndrome of the elbow is often treatable with non-operative management. A rehabilitation program to improve strength, flexibility and elbow range of motion may be helpful. Injections into the posterior compartment (back) of the elbow are often useful to reduce the inflammation and swelling.

When non-operative measures have failed, or particularly if there is locking and catching due to bone fragments within the joint and spurs, arthroscopic surgery is required to remove them.

Occasionally, the bony impingement is too close to the nearby ulnar nerve, or too extensive, for arthroscopy to be the best option. In this case, an open surgery can be performed to remove the impingement lesions.

If there is significant ligament compromised, ligaments may need to be reconstructed.

Postoperative care and recovery

Return to work and normal function will vary depending on what has been done to the elbow. As a minimum, there should be two weeks off work and driving, but it could be longer.

Unless told otherwise, gentle elbow motion can begin the day after surgery and the sling discarded when comfortable. Return to sports after this surgery may take up to three months.

Risks and complications

As with all surgery, risks and complications can occur, but the risk factors are very low. Most studies report a slightly higher risk of infection and nerve irritation or injury following elbow arthroscopy as compared to arthroscopy of the shoulder and knee joints.