Radial head excision/synovectomy for Rheumatoid disease

April 24th, 2007

Rheumatoid disease commonly affects the elbow and causes pain with motion. Interestingly, however, even when joint space narrowing between the ulna and humerus is present on an xray, a patient's flexion and extension may be functional, and relatively pain-free. Close examination in such cases may reveal that most of the symptoms are at the radiocapitellar joint--especially with forearm rotation.

In these cases, a cortisone injection may help to decrease inflammation and settle down pain. If not, there may be a role for limited surgery--holding off on the more complex option of total elbow replacement.

The radial head can be resected, and a synovectomy performed. This option provides superb pain relief, and may obviate the need, altogether, for future elbow replacement. It's worth noting that the results of total replacement after this type of first stage surgery are not compromised, which supports a limited surgical approach when symptoms are isolated to the lateral side of the joint--regardless of what the xray may show.

Related Photos:

Preop AP xray shows joint space narrowing, but flexion and extension were pain-free. Rotation was painful

preoperative lateral xray

Postoperative AP xray after radial head excision and synovectomy

Postoperative lateral xray

Postoperative elbow flexion

Postoperative elbow extension