APEX Elbow Mastering Surgical Techniques for Clinical Success-Tennis Elbow, Elbow Tendinopathy

Video Transcription

Video Summary

The speaker advises starting elbow arthroscopy anterior-first in osteoarthritis cases to minimize morbidity: anterior work prevents needing a later open anterior exposure on a swollen elbow, while posterior work can remain minimally invasive (small medial incision, protect ulnar nerve, no muscle cutting). They note fluid tends to extravasate more posteriorly due to a weaker capsule and less cannula use.<br /><br />The discussion then shifts to tennis elbow (lateral epicondylitis), presented through three cases with MRI showing a spectrum from low-grade partial extensor tendon tear to near-complete tear with possible ligament involvement. MRI can guide—but not dictate—treatment. They emphasize ruling out mimickers such as distal biceps pathology, radial tunnel syndrome, plica, radiocapitellar arthritis, referred pain, and subtle instability.<br /><br />Nonoperative care dominates (education, activity modification, splints, NSAIDs, therapy; selective single steroid injection with caution). For surgery, they outline an arthroscopic debridement/decortication technique emphasizing safe portal placement and avoiding injury to the lateral ulnar collateral ligament. Poor outcomes correlate with severe MRI defects and factors like multiple steroid injections, obesity, smoking, and OA; knotless anchors may improve repairs.

Asset Caption

Moderator: S. Joshua Szabo, M.D.

Keywords

elbow arthroscopy anterior-first approach

elbow osteoarthritis fluid extravasation posterior capsule

lateral epicondylitis tennis elbow MRI grading

differential diagnosis radial tunnel plica radiocapitellar arthritis

nonoperative management splint NSAIDs therapy steroid injection

arthroscopic extensor tendon debridement decortication LUCL protection knotless anchor repair