DEAR MAYO CLINIC: I've recently been diagnosed with a cracked bone spur in my elbow. I'm in quite a bit of pain, and it's hard to move my elbow. My doctor recommends surgery. What does that involve, and how long is the recovery time?
Surgery often is a good choice for treating elbow bone spurs that are causing problems. In many cases, it can relieve pain and restore mobility. Using new techniques that reduce inflammation after surgery, recovery time typically is short. In most cases, people can return to activities of daily living in a week or less, and to high-demand activities within two to six weeks.
Bone spurs are bony projections that develop along the edges of joints like your elbow. They are often caused by long-term wear-and-tear or prior injury to the joint.
In many cases, bone spurs don't cause any symptoms and don't require treatment. However, if a number of bone spurs build up in one joint, or if one cracks or breaks as in your situation, that can lead to pain and a loss of mobility in the joint. In the elbow, a cracked bone spur can make it difficult to fully extend or bend your arm. Surgery to remove the bone spur may eliminate the problem.
The surgery involves removing the cracked piece and using a high-speed, motorized instrument to grind off a bone spur. This is a procedure that requires experience and skill because three major nerves are situated very close to the elbow joint. In some cases, the surgeon needs to remove a bone spur that's just a millimeter or two away from one of those nerves. Experienced surgeons, however, regularly use techniques that enhance the safety of this procedure, which lowers the risk of nerve injury.
After surgery, a key to moving toward a quick recovery is reducing the amount of inflammation that may occur in the joint. In the past, surgeons expected swelling and pain after surgery and assumed it was part of the healing process. Now, however, we've learned we can greatly reduce or eliminate that inflammation by simply squeezing extra fluid out of the elbow repeatedly during the first three days after surgery.
This is done using a device called continuous passive motion, or CPM machine. The patient rests his or her arm in a CPM. It moves the arm though a range of motion continuously day and night except for brief periods out of the machine. The result is that the fluid is expelled from the joint, much like wringing out a washcloth. To prevent the CPM process from being painful, patients are given a nerve block while they use the CPM for the first three days in the hospital.
After about three days, the pain is usually minimal and the CPM is used by the patient at home. By this time, many people don't need any pain medication and can move their elbow freely, often with almost a full range of motion. The remaining range of motion typically recovers as people use their elbow normally. In general, physical therapy is not required.
If you are interested in going forward with surgery to remove the bone spur, ask your doctor to recommend a surgeon who is skilled in elbow surgery and who works in an organization that uses CPM technology after surgery. Those factors will help ensure that the surgery will be effective and successfully relieve your symptoms. -- Shawn O'Driscoll, M.D., Ph.D., Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester.
Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. Email a question to firstname.lastname@example.org. For more information, visit www.mayoclinic.org.