A Cranial Approach to the Elbow for Osteophyte Removal

Introduction: Currently described approaches to the cranial elbow joint are invasive and require tenotomies and osteotomies. While effective in gaining access, a limited cranial approach may result in less morbidity and faster return to function postoperatively. The purpose of this study was to develop a surgical approach to the cranial elbow that would provide appropriate exposure for osteophyte removal from arthritic elbows with restricted ROM, while decreasing surgical trauma.

Materials and Methods: Ten cadaveric canine forelimbs were used for anatomical dissection to develop a surgical approach to the cranial elbow joint.

Results: An approach allowing access to the radial head and cranial ulna was achieved. A craniomedial skin incision was made extending from the distal humerus to the proximal radius and ulna. Dissection and retraction of surrounding muscles allowed visualization of the joint capsule. Larger vessels and nerves were isolated and preserved. A stab incision was made through the joint capsule, and manipulation of the limb allowed small rongeurs or a burr to enter the space and remove osteophytes.

Discussion/Conclusion: This initial study suggested that it may be possible to access the cranial elbow joint through a cranial approach, enabling removal of osteophytes to improve ROM. Additional studies to assess ROM pre- and postoperatively will determine the value of this approach and its clinical applications in the treatment of elbow arthritis. To date, we have had some success in two clinical cases with severe arthritis and decreased ROM.

Acknowledgment: This study was supported by the Veterinary Orthopedic Laboratory at the University of Tennessee College of Veterinary Medicine