Our Summary

This paper discusses a study on a new method for treating severe elbow arthritis, called selective total elbow denervation. This procedure involves disabling specific nerves in the elbow to reduce pain and improve function.

The study was carried out on 14 dead bodies, with the surgery performed by two experienced elbow surgeons. They used two different approaches to access the elbow, one from the side (lateral) and one from the middle (medial). They documented the length of the skin cuts, how far apart they were, and the number and location of nerves they found.

The results showed that they could find all the necessary nerves using both approaches. The number of nerves they found varied, but they were typically able to find one nerve from the musculocutaneous nerve, one to three from the radial nerve, one to three from the posterior cutaneous nerve of the forearm, one to three from the ulnar nerve, and one to three from the medial antebrachial cutaneous nerve. In addition, they found that the ulnar nerve was directly connected to the joint capsule.

The lengths of the cuts to access the elbow ranged from 10 to 18 cm, and the cuts were typically about 7.5 cm apart.

The researchers concluded that this method of denervation is possible and could be beneficial for patients with severe elbow arthritis. Surgeons who are considering this procedure should aim to disable the nerves from the musculocutaneous, radial, ulnar, and collateral ulnar nerves, posterior cutaneous nerve of the forearm, as well as medial antebrachial cutaneous nerves.

FAQs

  1. What is selective total elbow denervation?
  2. How was the study on selective total elbow denervation conducted?
  3. What were the findings of the study on selective total elbow denervation?

Doctor’s Tip

A helpful tip a doctor might tell a patient undergoing elbow surgery is to follow post-operative care instructions carefully to ensure proper healing and minimize the risk of complications. This may include keeping the elbow elevated, performing prescribed exercises or physical therapy, and avoiding activities that could strain the elbow. It is also important to attend all follow-up appointments with the surgeon to monitor progress and address any concerns.

Suitable For

Patients who are typically recommended for elbow surgery include those with severe elbow arthritis who have not responded to conservative treatments such as physical therapy, medications, and injections. These patients often experience significant pain, limited range of motion, and difficulty performing daily activities. Selective total elbow denervation may be considered for patients who have exhausted other treatment options and are seeking relief from their symptoms. Surgeons may also consider this procedure for patients with certain nerve-related conditions affecting the elbow, such as cubital tunnel syndrome or radial tunnel syndrome. Ultimately, the decision to recommend elbow surgery will depend on the specific patient’s symptoms, medical history, and overall health.

Timeline

Before the surgery, the patient would typically undergo a series of consultations with their orthopedic surgeon to discuss their symptoms, medical history, and treatment options. They may also undergo imaging tests such as X-rays or MRI to assess the extent of damage in the elbow joint.

On the day of the surgery, the patient would be prepped for the procedure, which may involve general anesthesia or a nerve block to numb the area. The surgeon would then make an incision in the skin to access the elbow joint. During the surgery, the nerves responsible for transmitting pain signals in the elbow would be identified and disabled. The length of the surgery can vary depending on the complexity of the case.

After the surgery, the patient would typically stay in the hospital for a few days for monitoring and pain management. They would be given instructions on how to care for the incision site and how to gradually start moving the elbow to prevent stiffness. Physical therapy may be recommended to help regain strength and range of motion in the elbow joint.

Over the following weeks and months, the patient would gradually recover from the surgery, with improvements in pain and function as the nerves heal and adapt to the changes. Follow-up appointments with the surgeon would be scheduled to monitor progress and make any necessary adjustments to the treatment plan. With proper rehabilitation and adherence to post-operative guidelines, the patient can expect to see significant improvements in their elbow arthritis symptoms.

What to Ask Your Doctor

Some questions a patient should ask their doctor about elbow surgery include:

  1. What specific nerves will be targeted during the surgery?
  2. How will disabling these nerves improve my pain and function in the elbow?
  3. What are the potential risks and complications associated with selective total elbow denervation?
  4. What is the success rate of this procedure in relieving pain and improving function in patients with severe elbow arthritis?
  5. What is the expected recovery time after the surgery?
  6. Are there any alternative treatments or procedures that I should consider before undergoing this surgery?
  7. How experienced is the surgeon who will be performing the procedure?
  8. Will I need physical therapy or rehabilitation after the surgery?
  9. What are the long-term outcomes and potential limitations of this procedure?
  10. How soon can I expect to see improvements in my elbow pain and function after the surgery?

Reference

Authors: Laumonerie P, Robert S, Tibbo ME, Lupon E, Chaynes P, Bonnevialle N, Mansat P. Journal: J Hand Surg Am. 2022 Feb;47(2):193.e1-193.e7. doi: 10.1016/j.jhsa.2021.04.017. Epub 2021 May 29. PMID: 34074568