Supine Arthroscopy for Lateral Epicondylitis
Lee Hunter MD, MBA
Hunter Medical Founder and Chief Medical Officer
Lateral epicondylitis usually resolves spontaneously. Persistent cases are readily amenable to arthroscopic treatment. Supine elbow arthroscopy is faster, optimizes patient airway access, and is more intuitive than lateral decubitus or prone positioning.
40 YO RHDM CONSTRUCTION WORKER WITH RECALCITRANT LATERAL EPICONDYLITIS
The patient had right elbow lateral epicondylitis for more than a year. Conservative treatment included activity modification, two separate cortisone injections, bracing, and supervised physical therapy. Routine x-rays were unremarkable. No additional imaging studies were obtained. Due to continued symptoms and functional disability arthroscopy was recommended.
The patient was positioned supine utilizing the ElbowLOC® Arm Positioning System. Standard anteromedial, anterolateral, soft spot, and posterior midline arthroscopic portals were developed. An impressive full thickness tear of the wrist extensor origin was found and is shown, along with other aspects of the joint, in the photos below. Degenerative tendon tissue and capsule were debrided. The tendon origin on the lateral epicondyle was abraded with a curette and smoothed with a shaver to promote vascular ingrowth into the area and healing. The patient was essentially pain free within 48 hours post op. He had resumed his normal job duties with near normal grip strength and was pain free by 6 weeks.
Figure 1 Wrist Extensor Origin Tear
Figure 2 Coronoid and Medial Joint View
Figure 3 Radial Head, Capitellum, and Sigmoid Notch View via Soft Spot Portal
Figure 4 Radio-Capitellar Joint View
Figure 5 Intraoperative View 1
Figure 6Intraoperative View 2
With supine positioning for elbow arthroscopy, the anterior capsule naturally tends to sag away from the articular surface. This simplifies navigation and improves visualization. Posterior compartment arthroscopy is greatly facilitated by the surgeon’s ability to “dial In” the desired static elbow extension, relaxing the triceps and thus opening up the posterior aspect of the joint. Given these benefits, the optimized patient airway access, and the marked time savings versus lateral or prone positioning, it’s easy to see why supine elbow arthroscopy is becoming so popular. Additionally many surgeons have found that the unique ability to hold the humerus fixed vertically, while maintaining unrestricted control of the forearm accelerates procedural times significantly.