Loose Bodies
In this condition, there are loose cartilage or small bony fragments floating within the joint space. These can occur after injuries or with early arthritis, where there is damage to the cartilage or bone.
Patients can present with pain or locking (where the elbow becomes stuck in a particular position and may require a ‘trick’ movement to release it). The locking may be infrequent, but for some patients it may affect their daily activities and work.
How is the diagnosis made?
This is predominantly based on the history given by the patient. Examination at the time of consultation may be normal, but sometime patients can demonstrate the locking.
X-rays are usually taken, but these may be normal. Often scans are required. A CT scan will show bony loose bodies adequately, but an MRI may demonstrate the cartilaginous loose bodies better.
What is the treatment?
If the locking only occurs very occasionally, or it does not interfere with daily activity, then it can be treated conservatively with avoidance of the movement that can cause the locking.
However, if problematic, then surgery can be performed. This is usually carried out arthroscopically (keyhole), but the skin wounds may have to be made bigger depending on the size of the fragments being removed. The surgery is performed under general anaesthetic as a day case procedure.
The locking shoulder resolve immediately afterwards. There will be dressings and bandages but the elbow will be mobilised immediately. The sutures will need removing at 2 weeks. The rehabilitation process will be dependent on the treating surgeon and will be discussed in details.
Risks of Surgery
Surgery carries the risks of infection, bleeding, nerve injury, stiffness, failure of the procedure and recurrence of the loose bodies/symptoms.