Name:
Elbow Stiffness - Arthroscopic Release 40 Years After Index Trauma
Description:
Elbow Stiffness - Arthroscopic Release 40 Years After Index Trauma
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Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello, my friends, [how are you? I'm Dr. Sergio Rowinski, from SHOULDERPLANET, here from the city of São Paulo, Brazil. In this video, I'm showing you a very nice case about a 46-year-old man who had a trauma 40 years before when he was only six. He developed, after that, a severe stiffness.
He could only extend until 90 degrees, his left elbow, and he stood like that for 40 years. He came to me with a distal clavicle arthritis in the right shoulder, which we operated, and then we investigated the elbow problem. And after all of the investigation, we decided to do, 40 years, 40 years after the trauma, an arthroscopic elbow release. The final outcome was lovely.
And his case shows us how interesting arthroscopy can be, when we deal with these complex cases. So I hope you like the video. Please subscribe. Give us your thumbs up, and let's see the video. Elbow stiffness is a very common problem following elbow trauma or even elbow surgery. When conservative management fails, what usually happens generally, generally after six months, open release have been historically indicated with various results.
Much more recently, arthroscopic release has shown to be a very interesting tool to deal with such problems, and better and better results are being reached every time. This case is a very nice example of how useful arthroscopy can be in such cases. So this case is about a 46-year-old man, who had a fracture in his left elbow when he had only six years old, and developed stiffness just a couple months after that trauma.
Since then, his left elbow had full flexion, but his extension became very limited, since he could not extend his left elbow more than 90 degrees. As he grown up he had to adapt to such situation, and, in the last 10 years, three different doctors had said that his left elbow stiffness would never have a good solution.
He didn't have pain, but since he could extend his elbow only to 90 degrees, his left hand was much less used than it really should be. This patient came to me one year ago, with a AC advanced degenerative condition in his right shoulder, and, in January 2010, we performed an arthroscopic Mumford, an arthroscopic distal clavicle
resection, in his right shoulder, and he had a very, very fast and good recovery. And then I told him that we could investigate his left elbow stiffness, and that, perhaps, we could release it arthroscopically. Initially, we asked for some X-rays. This is a plane lateral view, in full flexion of his left elbow, as we are seeing now in which we can see no bony problems,
And this is the lateral view, in full extension, in which there is no evidence of any kind of bony problems, too. We asked for Some CT scans, and the CT scans revealed a quite preserved bony anatomy. This is the lateral view, in which we can see the lateral column, and this one is the front view, in which we can see a quite normal distal humerus bony anatomy.
And this is the medial view, in which we can see a quite normal ulno-humeral joint. An MRI is a very important exam in this case, because such a patient should not have arthritis if we think of releasing this elbow. it's very important to say that, once a patient has a stiff elbow and arthritis, he doesn't have pain only because his elbow doesn't move. Once the elbow starts to move, pain will surely come due to previous arthritis.
In this image, we can see that the distal humerus cartilage was incredibly intact. And, in this image, we can see that not only the distal humerus cartilage was in nice shape, but the radial had cartilage was in good shape, too. In the lateral view, still in the MRI, it's very clear that the radial head was definitely deformed and that the anterior capsule was intensely retracted. After discussing this case, with a lot of care,
we decided to perform an arthroscopic release of this left elbow. So this is his arthroscopy, a very thick capsule, this is a left elbow, We started working throug the lateral portal, releasing all the very thick anterior capsule he had, now we are seeing, in the upper part, the capitellum and in below the radial head.
We are removing the lateral parts of the anterior capsule with a shaver, taking a lot of care not to damage the interosseous nerve, now we are taking the capsule with a basket, or with a soft tissue shaver, still working through the lateral portal. Now we are working through the medial portal, releasing the anterior capsule, until we found the brachialis tendon. And now we are still releasing the soft tissue,
now we have already found the brachialis tendon, this is the brachialis tendon, and we are working to see the coronoid. This is the brachialis tendon, and now we are just about to see the tip of the coronoid process. This is the tip of the coronoid. We are flexing the elbow, but still we were unable to extend the elbow. This is the tip of the coronoid.
And, at that moment, so we decided to switch the portals again, and to perform a full resection of the radial head. Now we are starting through the lateral portal to reserct all of the radial head, and, once the radial had would be fully resected, we could resect a little part of the capitellum, if necessary, and it was.
So now we are taking a little part of the capitellum, in order to make resection of the radial easier, and still removing a lot of bone since we we were doing it arthroscopically. We had to pronate and supinate the forearm, as we are seeing now, to make resection easier. And then we had to establish an alternative portal, as we are seeing now, in order to achieve a full resection of the radial head.
This is a more posterior portal, very safe portal. And,then, through this alternative portal, we could achieve all of the parts of the radial head. Now we are finishing the radial head resection and using a soft tissue shaver. This is the final part of the resection, still working through the new lateral portal. Now, the radial head resection was almost finished, and now we are seeing the semilunar fossa through lateral portal. After surgery,
the patient used an articulated orthosis, like this one shown here, for about six weeks, 24 hours a day, moving from forced flexion to forced extension, every six hours. He started physical therapy about two weeks after surgery, and now he has three months of surgery, since he was operated in July, the 2nd 2010. He has already gained almost full flexion, but we are not really worried about that, since he never had problems with flexion.
He has already reached 25 degrees of extension, and as we are seeing now, what means that, in only three months he gained amazing 65 degrees of extension of his left elbow. He will keep physical therapy for more 3 months, but he says that, by now, he's fully satisfied with his result. In this photo, we can see that he
already has full supination in his forearm, and, in this another image, we can see that he already has gained full pronation, too. So this case is an interesting example of how useful arthroscopy can be, and that better outcomes can be achieved, with minimal tissue destruction, and faster recoveries. Thank you. So I hope you liked the video,
please, don't fohrget, show it to your friends, help me spread the channel, subscribe, and see you in the next video. As Dr. Sergio always says, never stop flying. Bye
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