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Mr. Mark Falworth, Consultant Orthopaedic Shoulder & Elbow Surgeon, London, Watford, Stanmore, UK / Elbow / Loose Bodies

Loose Bodies

The formation of loose bodies in the elbow is usually a sign of degenerative change and osteoarthritis. Their presence can be merely an incidental finding when the elbow is being investigated for pain and stiffness, but they may also cause specific symptoms of locking and episodes of sudden severe pain. If so they can be removed with the size of the loose body will usually dictating the technique needed to remove them. Arthroscopic (key hole) or open techniques may both be used to remove them.

Symptoms

The symptoms associated with elbow arthritis include;

  • Pain; the pain associated with a loose body is usually sudden and severe in nature. A deep-seated aching pain may also be present if there is any significant underlying osteoarthritis.
  • Locking of the joint may be noticed if the loose body impedes joint movement. Episodes of locking will often settle spontaneously but will also often recur.
  • Stiffness; restrictions in the range of elbow movement is common when there is underlying osteoarthritis.

Causes & Risk factors

There are several different types of arthritis that affect the elbow but the most common is primary osteoarthritis. Osteoarthritis is a degenerative condition with no obvious cause but if arthritis develops as a result of another condition it is called secondary. Examples of this form of arthritis include:

  • post traumatic arthritis (as occurs following a fracture)
  • instability arthropathy (following recurrent elbow instability / dislocations)
  • rheumatoid arthritis secondary to chronic inflammatory joint disease.
  • septic arthritis following a joint infection

Diagnosis

The diagnosis of loose bodies in the elbow is largely made on a history and examination however their presence is confirmed with the use of x-rays. However, due to the complicated nature of the elbow joint, CT scans can also prove helpful in determining the size and location of any loose bodies.

Treatment

The treatment of loose bodies of the elbow is always tailored to the particular patient, but essentially arthroscopic (key hole) or open techniques may both be used to remove them.

  1. Arthroscopic loose body removal; keyhole techniques can be used to removal small loose bodies. In using this tech two or three small incisions are placed around the elbow so that the loose bodies can be removed arthroscopically. A release of the capsule can also be undertaken using this method however, larger osteophytes may need to be removed using open techniques such as an OK procedure.
  2. Outerbridge – Kashiwagi (OK) procedure; this procedure is used to debride the elbow joint thereby removing any loose bodies as well as releasing any soft tissue contractures so that any restricted movement can be addressed. It is undertaken as an open procedure through an incision at the back of the elbow, or sometimes as an arthroscopic procedure. A fenestration is made through the bone of humerus from within the elbow joint, so that both the back and front aspects of the joint can be accessed. Any loose bodies, osteophytes and capsular contractions can then be addressed.