Outerbridge-Kashiwagi (OK) Procedure

The 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 a 10cm incision 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 removed or released thereby restoring elbow movement.

Information for patients / operative Information

Risks and complications

• Infection
• Bleeding
• Nerve injury
• Continued discomfort
• Residual or recurrentelbow stiffness

Before admission

• Please bring any X-rays or scans with you to the hospital. This will usually be on a CD disc. These will not be needed if it was Mr. Falworth who organised the investigations.
• No food for 6 hours, or drink for 4 hours, prior to surgery.
• Please avoid smoking for 12 hours prior to surgery

In Hospital

• An elbow OK procedure can be undertaken as a day case of single overnight stay procedure.
• A single incision measuring approximately 10cm is made over the back of your elbow.
• The wound is repaired with dissolving buried sutures and Steri-strips
• Splash proof dressings will be applied but the wound should remain dry for 10 days.
• For the first 24 hrs after your operation you may be placed with your arm in extension so as to rest the operative wound. You will then be placed in a sling.
• Prior to your discharge from hospital, a physiotherapist will demonstrate some simple exercises as part of your rehabilitation protocol. These exercises should be undertaken when you’re at home and will help your shoulder recover from the surgery before your outpatient physiotherapy commences.

What to Expect

• Swelling; immediately after an elbow operation there can be quite a lot of swelling around the elbow and hand. This settles after approximately 24-48 hours but can be speeded up if gentle finger movements are undertaken soon after the operation. The use of ice or alternative cold therapy compress, can be helpful in minimising swelling and inflammation.
• Pain; an Interscalene Block is often used to reduce immediate post-operative pain. If any discomfort arises once the block has worn off, simple oral analgesics can be taken to manage this. These will be provided to you upon discharge.
• Bleeding; there may be some oozing through the bandages but this should settle soon after the operation.

Post-operative care

• A sling will be provided to help rest the elbow during the day. This should be discarded as soon as possible, (usually between 3-7 days) so as not to encourage any recurrent stiffness.
• The wound should be kept dry for 10 days.
• At ten days the dressing and paper Steristrips can be gently removed. If the wound is ‘dry’ then it is all right to wash the wound, if not consult Mr. Falworth.
• The most important part of your post-operative care is to start an early exercise programme, which the ward physiotherapist will have commenced prior to discharge from hospital. This will maximise the benefit of your operation and will continue as an out-patient.

Post-operative appointments

• You will be reviewed in clinic approximately 3 weeks following your surgery.

Estimated return to functional activities