Skip to content

Clinicians › Elbow

Elbow arthroscopy

51 citationsUpdated Aug 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Elbow arthroscopy has evolved from a diagnostic tool to a therapeutic procedure with expanded indications, though it requires careful attention to surgical anatomy and patient selection to avoid neurovascular complications [6]. The available evidence supports its use in the management of the majority of conditions where it is currently indicated [2]. Advances in equipment and surgical technique have made elbow arthroscopy a safer and more effective treatment modality for several elbow pathologies [5]. Patients treated arthroscopically benefit from additional diagnostic techniques, improved visualization of the elbow joint, the ability to address coexisting intra-articular pathologic conditions, and minimal soft tissue injury with no clinical consequences in outcomes [3].

Despite these advantages, elbow arthroscopy is not without complications and morbidity [1]. Predominantly low-level evidence studies demonstrate varying complication rates (median 3%, range 0%-71%) and reoperation rates (median 2%, range 0%-59%) after elbow arthroscopy [10]. However, elbow arthroscopic surgery is generally considered a relatively safe procedure with low complication rates [31]. For example, elbow arthroscopic debridement for primary degenerative osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes with low complication and reoperation rates [23]. Similarly, pediatric elbow arthroscopy performed by an experienced surgeon using a standardized technique for a wide variety of elbow conditions has an acceptable complication rate that is similar to rates in the previously published literature on elbow arthroscopy in the pediatric and adult populations [15].

Elbow arthroscopy has expanded indications for diagnosing and treating acute trauma, including radial head fractures and instability, provided patients are carefully selected and neurovascular risks are managed with proper technique [12]. A significant proportion of pediatric patients needed subsequent surgery in the following years after elbow arthroscopy [15]. The purpose of this review is to enable orthopedic surgeons initiating elbow arthroscopy to approach it more safely and easily by describing history, setup, and indications [4].

Anatomy & Pathophysiology

Bony Anatomy

The elbow is a trocho-ginglymoid joint comprising medial and lateral articulations that provide bony stability [37]. The ulnohumeral joint is a highly congruent hinged articulation between the trochlea and the greater sigmoid notch of the ulna, featuring nearly 180° of articular contact except for the bare area of the greater sigmoid notch which lacks cartilage [37]. The coronoid process buttresses the trochlea anteriorly via medial and lateral facets, while the sublime tubercle, located just distal and medial to the coronoid, serves as the attachment site for the anterior bundle of the medial ulnar collateral ligament (MUCL) [37]. The distal humeral articular surface is angled 30° anterior to the humeral shaft axis [40] and 30° from the longitudinal axis of the humerus [37]. The anterior humeral line should pass through the center of the axis of rotation [37], which is angulated 5° to 7° in the coronal plane to the epicondylar axis with the medial side more distal than the lateral side [37]. This coronal angulation accounts for the change from a valgus carrying angle in extension to a more varus position as the elbow flexes [37]. The trochlea possesses a 300-degree arc of cartilage [42]. The distal humerus consists of medial and lateral columns that diverge from the humeral shaft at 45-degree and 20-degree angles, respectively [42]. The olecranon provides a broad posterior attachment for the triceps, and the proximal ulna bends approximately 8° medially at 8 cm from the olecranon tip [37]. The articulation to the coronoid tip is approximately 30° from the long axis of the ulna in the sagittal plane [37].

The radiocapitellar joint is formed by the capitellum and radial head, while the proximal radioulnar joint (PRUJ) involves the radial head articulating with the lesser sigmoid notch of the ulna [37]. The annular ligament holds the radius in close approximation to the ulna at the PRUJ [37]. The radial head is a concave elliptical structure covered with articular cartilage along the radiocapitellar joint and approximately 270° of its articular margin [37]. There is a high correlation between the size of the radius and capitellum within the same individual, aiding surgical planning when one structure is destroyed [37]. In full extension, 60% of axial load is transmitted through the radiocapitellar joint [40].

Ligamentous Anatomy

Elbow stability is conferred by bony articular anatomy and ligamentous structures on the medial and lateral sides [17]. The three primary stabilizers are the ulnohumeral articulation, the medial ulnar collateral ligament (MUCL), and the lateral ulnar collateral ligament (LUCL) complex [17]. Secondary stabilizers include the radiocapitellar articulation, common flexor tendon, common extensor tendon, and joint capsule [17].

The MUCL complex comprises the anterior bundle, posterior bundle, and transverse ligament [36]. The anterior oblique ligament of the MUCL complex is the strongest component and the primary stabilizer to valgus stress [18]. The anterior bundle originates on the anterior-inferior edge of the medial epicondyle and inserts on the sublime tubercle of the ulna [18]. This bundle is further subdivided into anterior and posterior bands providing reciprocal function, with the anterior band tight in extension and the posterior band tight in flexion [36]. The anterior bundle is the primary restraint to valgus stress within functional elbow ROM, with the radial head as a secondary restraint [40]. The posterior bundle of the MUCL is the primary restraint to valgus stress with the elbow in maximal flexion [40]. Stability in full extension is provided by the MUCL, joint capsule, and ulnohumeral articulation [40].

The LUCL complex originates at the geometric center of the radiocapitellar articulation on the lateral epicondyle [37]. The LUCL origin center is 10.7 mm from the lateral epicondyle and its insertion is 3.3 mm from the apex of the supinator crest [36]. The lateral collateral ligament complex includes the lateral ulnar collateral ligament, radial collateral ligament, and annular ligaments [36].

Normal Range of Motion

The normal elbow has a range of motion from 0° to 140° from extension to flexion [17]. Normal forearm rotation is 75° to 85° in pronation and supination respectively [17]. A functional arc of motion is 100° for flexion and extension and forearm rotation [17]. The normal range of elbow flexion/extension is 0 to 150 degrees [40]. Normal forearm pronosupination is 80 to 85 degrees in each direction [40]. Functional ROM is defined as 30 to 130 degrees flexion/extension and 50 degrees pronosupination [40]. The normal valgus carrying angle of the elbow is 5 to 10 degrees for men and 10 to 15 degrees for women [40].

Pathoanatomy of Specific Conditions

Valgus Extension Overload Syndrome: This condition involves chondrosis, osteophyte development on the posteromedial olecranon and humerus, and loose bodies [18]. During throwing, the olecranon is repeatedly driven into the olecranon fossa, exerting shear forces on the medial aspect of the olecranon tip and the olecranon fossa [18]. Medial ligamentous laxity commonly exacerbates this syndrome [18]. Patients report posteromedial elbow pain during the deceleration phase of throwing as the elbow reaches terminal extension, and pain may also occur during acceleration [18]. Loss of terminal elbow extension, crepitus, and tenderness over the posteromedial olecranon may be noted [18]. Pain is reproduced when the elbow is forced into extension, and an elbow flexion contracture may be seen [18]. AP, lateral, oblique, and axillary views may reveal posteromedial olecranon osteophytes and/or loose bodies [18]. CT with two-dimensional reconstruction and three-dimensional surface rendering best visualizes the pathology [18]. MRI may be most helpful in evaluating associated injuries including partial or complete tears of the MCL [18]. MCL insufficiency is a relative contraindication for isolated olecranon débridement in this syndrome [18]. Treating the secondary effects of MCL insufficiency without treating the underlying MCL pathology will lead to unsatisfactory results and an increased revision surgery rate [18].

Olecranon Resection: Olecranon resection increases valgus angulation and medial collateral ligament (MCL) strain during valgus stress [18]. Overaggressive olecranon resection may result in valgus instability of the elbow [18].

Elbow Osteoarthritis: This condition is characterized by osteophyte formation, capsular contracture, and loose bodies, often with relative preservation of the joint space [28]. Periarticular hypertrophic osteophytes act as a mechanical block at the end ranges of flexion and extension [28]. Osteoarthritis typically involves the radiocapitellar joint articular cartilage preferentially, with relative preservation of the ulnohumeral articular surfaces [28]. It is relatively rare, affecting 2% of the population, with an average age of presentation of 50 years [28]. Men are affected more often than women in a 4:1 ratio [28]. Hand dominance and strenuous manual labor are associated with primary elbow osteoarthritis [28]. Secondary causes include trauma, osteochondritis dissecans, and synovial osteochondromatosis [28]. Ulnar neuropathy is present in up to 50% of patients [28]. The condition typically presents with loss of terminal extension and flexion and painful catching/clicking or locking [28]. Pain is typically noted at the end ranges of motion and not through the midrange [28]. Night pain is not typical; if present, an inflammatory cause should be considered [28]. Forearm rotation is relatively preserved until later in the disease process [28]. Radiographs typically show osteophyte formation at the coronoid process, coronoid fossa, radial fossa, radial head, olecranon tip, and olecranon fossa [28]. Joint spaces at the ulnohumeral joint are usually preserved, while those at the radiocapitellar joint are mildly narrowed [28]. Radiographs typically underestimate the number of loose bodies present [28].

Osteochondritis Dissecans (OCD): OCD of the capitellum is caused by repetitive microtrauma to the vulnerable epiphysis which has a tenuous blood supply [53]. Repetitive loading of the lateral compartment of the elbow results in subchondral bone degeneration causing cartilage fragmentation in OCD [53].

Lateral Epicondylitis: This is an angiofibroblastic hyperplasia of the extensor carpi radialis brevis (ECRB) tendon, a noninflammatory, dysvascular degenerative process caused by repetitive microtrauma [53]. Up to 90% of cases are self-limiting, resolving within 1 to 2 years [53].

Elbow Stiffness: Intrinsic causes include articular damage or malunion, intraarticular hardware, and loose bodies [50]. Extrinsic causes include a contracted joint capsule and ligaments, heterotopic ossification, prominent hardware, and skin contracture [50]. Posttraumatic or postsurgical contractures typically involve a damaged, abnormally thickened joint capsule with altered anatomy [50]. In posttraumatic contractures, the joint space is usually contracted and the capsule is scarred down to the bones [50]. The anterior soft tissues are usually contracted, which may alter the locations of the median and radial nerves [50].

Throwing Mechanics and Injury: Valgus torque generated at the elbow during throwing maneuvers is highest in the late cocking and early acceleration phases [18]. Patients with MCL injuries report medial elbow pain during the acceleration phase, which may occur only when throwing at more than 50% to 75% of maximal effort [18].

Classification

Evolution and Indications: Elbow arthroscopy has evolved from a diagnostic tool to a therapeutic procedure with expanded indications [6]. Arthroscopy plays an increasing role in the treatment of elbow disorders as experience is gained and technology advances [7]. Patients treated arthroscopically benefit from additional diagnostic techniques, improved visualization of the elbow joint, and the ability to address coexisting intra-articular pathologic conditions [3]. Recent advances in arthroscopic instrumentation and techniques have led to growing interest in the arthroscopic treatment of elbow osteoarthritis [14].

Safety and Complications: Elbow arthroscopy is not without complications and morbidity despite being a minimally invasive procedure [1]. A significant proportion of patients from a large cohort of elbow arthroscopy patients visited the emergency department at least once in the 90 days following surgery [9]. Predominantly low-level evidence studies demonstrate varying complication rates after elbow arthroscopy, with a median of 3% and a range of 0%-71% [10]. Predominantly low-level evidence studies demonstrate varying reoperation rates after elbow arthroscopy, with a median of 2% and a range of 0%-59% [10]. Heterotopic ossification (HO) is a minor complication of elbow arthroscopy with a prevalence rate of 6.3% [32]. Heterotopic ossification after elbow arthroscopy is usually located on the medial compartment of the elbow [32].

Evidence Base: The majority of the top 50 cited articles in elbow arthroscopy comprised case series exhibiting Level IV or V evidence [8].

Other Considerations: Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint [16]. Elbow arthroscopy is a valid and safe option for the diagnosis and treatment of both acute and chronic elbow instability [20]. Arthroscopic treatment of elbow instability involves minimal soft tissue injury with no clinical consequences in outcomes [3]. Arthroscopy allows for the management of soft tissue lesions and associated intra-articular bone or cartilage lesions with minimal disruption in elbow instability cases [20].

Clinical Presentation

The evaluation of the elbow requires an intimate understanding of its anatomy, biomechanics, and diagnostic tests [17]. The normal elbow has a range of motion from 0° to 140° from extension to flexion and 75° to 85° in pronation and supination [17]. A functional arc of motion in the elbow is 100° for flexion and extension and forearm rotation [17] [54]. Elbow stability is conferred by bony articular anatomy, which is highly congruent, and ligamentous structures on the medial and lateral sides [17]. Secondary stabilizers of the elbow include the radiocapitellar articulation, the common flexor tendon, the common extensor tendon, and the joint capsule [17].

A thorough history and physical examination are invaluable to understanding the type of disease process and its impact on the patient [54]. The physical exam is directed by history and the location of pain in the anterior, posterior, medial, or lateral aspect of the elbow [17]. The location, quality, context, duration, and severity of elbow pain help focus the physical examination [63]. Determining the symptom trajectory (whether pain is improving, worsening, or remaining constant) is helpful when considering intervention [63]. Understanding whether a patient has pain throughout the arc of motion or only at terminal limits, along with associated mechanical symptoms or instability, is paramount [54]. Associated conditions such as cubital tunnel syndrome must be considered and evaluated to provide optimal management recommendations [54]. Evaluating findings in the context of the patient’s age, activity level, expectations, and handedness guides shared decision-making [54].

Physical examination of the elbow should focus on functional anatomy, including inspection, palpation, range of motion, strength, stability, and special tests [63]. The examination elements are dynamic, and adequate assessment often combines examination maneuvers to fully elucidate elbow pathology [63]. Plain radiographs remain the hallmark and best screening test for elbow evaluation [17]. CT scans with 3D reconstructions may be useful for evaluating the extent and location of disease and for surgical planning [54]. MRI may be useful to evaluate the status of soft tissues, including the medial and lateral collateral ligamentous complexes [54]. Electromyography and nerve conduction studies (EMG/NCS) may be useful to evaluate the degree of nerve compression and its contribution to elbow pain or dysfunction [54].

Lateral Elbow Pathology

Lateral elbow tendinopathy ("tennis elbow") presents with pain lifting things from a bag with a pronated hand, turning doorknobs, taking milk from the fridge, shaking hands, or taking a laptop out of a bag [63]. Physical examination includes direct palpation of the ECRB origin, the tennis elbow shear test, and pain with resisted wrist or long finger extension [63].

Posterolateral rotatory instability presents with a feeling of giving way or instability when pushing out of a chair with arms [63]. Physical examination includes the PLR drawer, PLR pivot shift, and supinated push-up test [63].

Plica may present with a pop associated with pain that then "feels better" [63]. Physical examination includes direct palpation eliciting a "click" with flexion and pronation (anterior) or extension and supination (posterior) [63].

Radiocapitellar arthrosis presents with distant trauma or surgery and pain with the RC load test (pain with pronation and resisted extension) [63].

Osteochondritis dissecans (OCD) or osteonecrosis presents with gradual loss of motion with or without pain, and catching and locking if loose bodies are present [63]. Physical examination includes the RC load test (pain with pronation and resisted extension) [63].

Partial biceps tendon tear presents with pain in the lateral arm with resisted supination [63]. Physical examination includes direct palpation of the radial tuberosity with the arm in pronation, which elicits crepitus and pain [63].

Medial Elbow Pathology

Medial elbow tendinopathy or tendon tear presents with pain washing the face or carrying objects with the arm in a supinated position [63]. Physical examination includes direct palpation of the flexor-pronator tendon origin, the face press examination, the server tray examination, and resisted flexion tests [63].

Ulnar neuritis or neuropathy presents with the ring and small finger going to sleep when the elbow is flexed, such as while reading in bed or waking them up at night [63]. Physical examination includes direct palpation and the Tinel test [63].

MUCL strain, tear, or instability presents with decreased control and velocity while pitching in athletes, or a history of trauma and dislocation [63]. Physical examination includes the milking maneuver and the moving valgus stress test [63].

Valgus extension overload presents with decreased range of motion and pain with deceleration and follow-through [63]. Physical examination includes the valgus extension overload examination and the arm bar examination [63].

Varus posteromedial rotatory instability presents with decreased range of motion after traumatic dislocation, continued varus deformity, and pain with activities with the arm away from the body [63]. Physical examination includes the gravity-assisted varus grind test [63].

Ulnohumeral arthritis presents with a history of inflammatory conditions or trauma and painful range of motion through the midarc with or without a load [63].

MABCN neuroma or neuritis presents with localized pain or burning with an area of hypersensitivity over an area of injury or prior surgery [63]. Physical examination includes palpation or the Tinel test [63].

Median nerve compression presents with vague forearm pain that may radiate from the hand to the forearm [63]. Physical examination includes palpation or the Tinel test [63].

Valgus Extension Overload Syndrome

Valgus extension overload syndrome is caused by repetitive and forceful driving of the olecranon into the olecranon fossa during throwing, exerting shear forces on the medial aspect of the olecranon tip and the olecranon fossa [18]. The pathoanatomy includes chondrosis, osteophyte development on the posteromedial olecranon and humerus, and loose bodies [18]. Olecranon resection increases valgus angulation and MCL strain during valgus stress [18].

Patients with valgus extension overload report posteromedial elbow pain that occurs during the deceleration phase of throwing as the elbow reaches terminal extension, and pain may also occur during acceleration [18]. Physical examination may reveal crepitus and tenderness over the posteromedial olecranon, pain reproduced when the elbow is forced into extension, and elbow flexion contracture [18]. Imaging may reveal posteromedial olecranon osteophytes and/or loose bodies on AP, lateral, oblique, and axillary views [18]. Careful evaluation of possible concomitant MCL injury is required, as treating secondary effects of MCL insufficiency without treating the underlying MCL pathology leads to unsatisfactory results and increased revision surgery rates [18].

Medial Collateral Ligament (MCL) Injuries

The MCL complex comprises three ligaments: the anterior oblique, the posterior oblique, and the transverse [60]. The anterior oblique ligament is the strongest and is the primary stabilizer to valgus stress [60]. The anterior oblique ligament is composed of anterior and posterior bands that provide reciprocal function in resisting valgus stress through the range of flexion-extension motion [60]. The anterior band of the anterior oblique ligament is taut in extension, and the posterior band is tight in flexion [60]. The anterior oblique ligament originates on the anterior-inferior edge of the medial epicondyle and inserts on the sublime tubercle of the ulna [60].

MCL injuries occur in overhead athletes who subject their elbows to tremendous valgus forces [60]. Valgus torque generated at the elbow during throwing maneuvers is highest in the late cocking and early acceleration phases of throwing [60]. The olecranon stabilizes valgus stress to the elbow, and excessive resection places the MCL at risk [60]. The surrounding elbow musculature, specifically the flexor digitorum superficialis and flexor carpi ulnaris, provide a dynamic stabilizing force across the elbow joint and may be protective of the static restraint of the MCL [60].

Acute MCL injuries may present suddenly with a pop, sharp pain, and inability to continue throwing [60]. Physical examination may reveal point tenderness at the MCL or toward its insertion sites [60]. Valgus instability is tested with the patient’s elbow flexed between 20° and 30° to unlock the olecranon from its fossa as valgus stress is applied [60]. The milking maneuver involves pulling on the patient’s thumb to create valgus stress while the forearm is supinated and the elbow is flexed beyond 90°; a subjective feeling of apprehension, instability, or localized pain at the MCL indicates injury [60]. The moving valgus stress test applies valgus stress while the elbow is moved through an arc of flexion or extension; a subjective feeling of apprehension, instability, or localized pain at the MCL indicates injury [60].

Valgus stress radiographs with the elbow in 20° to 30° of flexion and the forearm in full supination may be used to measure medial joint line opening; greater than 3 mm is considered diagnostic for valgus instability [60]. Conventional MRI can help identify thickening within the ligament from chronic injury or more obvious full-thickness tears [60]. Magnetic resonance arthrography enhanced with intra-articular gadolinium improves the diagnosis of partial undersurface tears [60]. Dynamic ultrasonography can help detect increased laxity with valgus stress, although diagnostic quality is operator dependent [60].

Osteoarthritis

Symptomatic primary osteoarthritis of the elbow affects 2% of the population [28]. The average age of presentation for primary elbow osteoarthritis is 50 years (range, 20 to 70 years) [28]. Men are affected more often than women with primary elbow osteoarthritis (4:1 ratio) [28]. Periarticular hypertrophic osteophytes act as a mechanical block at the end ranges of flexion and extension [28]. Advanced elbow osteoarthritis rarely presents with joint space narrowing [28].

Patients with elbow osteoarthritis typically present with loss of terminal extension and flexion and painful catching, clicking, or locking [28]. Pain from elbow osteoarthritis is typically noted at the end ranges of motion and not through the midrange [28]. Pain in elbow osteoarthritis is usually felt at the end ranges of flexion and extension rather than throughout the arc [28]. Inspection for elbow osteoarthritis should check for prior surgical incisions and joint effusion at the lateral soft spot [28].

Radiographs for elbow osteoarthritis typically show osteophyte formation at the coronoid process (anterior and medial), coronoid fossa, radial fossa, radial head, olecranon tip, and olecranon fossa [28]. Loose bodies may be evident on radiographs for elbow osteoarthritis, and radiographs typically underestimate the number present [28]. CT may be useful for surgical planning in elbow osteoarthritis, allowing detailed assessment of osteophytes and the presence of loose bodies [28].

Pediatric Elbow Pathology

Osteochondritis dissecans (OCD) must be differentiated from Panner disease [18]. OCD is more common in skeletally immature athletes who engage in repetitive activities, such as throwing or gymnastics [18]. Physical examination findings in capitellum OCD include lateral elbow tenderness, crepitus, and often a 15° to 20° flexion contracture [18]. Initial treatment of stable OCD lesions includes activity modification, avoidance of throwing or related sports, NSAIDs, and occasionally a short period of immobilization for acute symptoms [18]. Unstable OCD lesions with gross mechanical symptoms require surgical repair [18].

Investigations

Plain radiography: Plain radiographs (AP, lateral, and oblique views) are the hallmark and best screening test for elbow evaluation [17]. Serial radiography is used as follow-up when heterotopic ossification is present [44].

CT: CT is helpful for assessing malunion architecture, the location and pattern of osteophytes, and loose bodies [44]. Three-dimensional CT is used to check for heterotopic ossification [44]. CT is not necessary when elbow stiffness is entirely soft-tissue related, but is beneficial if joint incongruity or abnormal bony anatomy is present [44]. CT can be helpful in identifying mineralized intra-articular loose bodies or delineating the anatomy of a complex intra-articular fracture [45]. CT with two-dimensional reconstruction and three-dimensional surface rendering best visualizes posteromedial olecranon osteophytes and loose bodies in valgus extension overload syndrome [18].

MRI: MRI is the imaging modality best suited for evaluating soft-tissue structures in the elbow, including ligaments, tendons, cartilage, and nerves [45]. Conventional MRI sequences should be obtained in all three planes using T1-weighted and fluid-sensitive sequences (STIR or T2-weighted with fat suppression) [45]. Coronal MRI studies should be obtained along a line connecting the medial and lateral epicondyles [45]. Sagittal MRI studies should be perpendicular to the coronal studies [45]. 3-Tesla MRI units generate high signal-to-noise ratios and show normal anatomy better than 1.5-Tesla units, but may show mild signal alterations in tendons, ligaments, and nerves that are not symptomatic [45]. Magnetic resonance arthrography (MRA) is particularly beneficial for evaluating osteochondral lesions, loose bodies, and ulnar collateral ligament (UCL) injury in throwing athletes [45]. MRI may be most helpful in evaluating associated injuries, including partial or complete tears of the medial collateral ligament (MCL), in valgus extension overload syndrome [18]. MRI can be used to evaluate ligaments and tendons in elbow stiffness, but is rarely indicated [44].

Ultrasonography: Ultrasonography is most useful for evaluating the distal biceps and common flexor and extensor tendons [45]. Ultrasonography allows dynamic imaging, which may be useful for evaluating ulnar nerve subluxation or a snapping triceps [45]. Ultrasound imaging of the elbow includes techniques and normal appearance of anatomic structures [24].

Other Considerations: MRI findings of structural changes in the elbow predict injuries and surgery in major league baseball pitchers [24]. Interobserver and intraobserver reliability exists for an MRI-based classification system for UCL injuries [24]. MR evaluation can identify soft-tissue lesions resulting from simple elbow dislocations [24]. MRI is used to evaluate the reconstructed ulnar collateral ligament [24]. MRI findings in acute elbow dislocation provide insight into the mechanism of injury [24]. Elbow MR imaging findings are described for patients with synovial fringe syndrome [24]. Normal and variant anatomy of the elbow can be assessed on MRI [24]. MRI variants and pitfalls exist in elbow imaging [24]. MRI findings of osteochondritis dissecans of the capitellum have surgical correlation [24]. Pediatric elbow injuries can be evaluated with MRI [24]. Needle arthroscopy is described as an initial diagnostic and therapeutic step for suspected bacterial arthritis of the native elbow under local anesthesia [67]. Routine diagnostic arthroscopy preceding ulnar collateral ligament reconstruction does not significantly reduce the proportion or rate of subsequent surgery for valgus extension overload conditions [68].

Treatment

Arthroscopy is emerging as an invaluable tool for diagnosing and treating elbow pathology, offering advantages such as less scarring, decreased risk of infection, and less postoperative pain [19]. As greater experience is gained and technology advances, arthroscopy will play more of a role in the treatment of elbow disorders [7]. Recent advances in arthroscopic instrumentation and techniques have led to growing interest in arthroscopic treatment of elbow osteoarthritis [14].

Operative

Indications: Arthroscopy is indicated for a wide variety of elbow conditions in pediatric patients [15], elbow stiffness requiring arthroscopic arthrolysis [11], and unreconstructible radial head fractures requiring excision [51].

Surgical Approach / Technique: Patient positioning is based primarily on surgeon preference, with options including supine, modified supine, lateral decubitus, and prone positions [61]. The modern concept of arm suspension from the supine position keeps the arm in 90° of shoulder abduction and 90° of elbow flexion [61]. Advantages of the supine position include simplified airway access, familiar orientation, and ease of conversion to an open procedure [61]. Disadvantages of the supine position include elbow instability during the procedure and difficult access to the posterior compartment [61]. The modified supine position suspends the arm over the chest with the elbow in 90° of flexion while the forearm, wrist, and hand are secured in a commercially available mechanical holder [61]. This position facilitates easy arm adjustment, providing access to both the anterior and posterior compartments of the elbow [61]. The modified supine position decreases the risk of injury to the anterior neurovascular structures by allowing them to drop away from the anterior capsule [61]. In the lateral decubitus position, the patient is positioned laterally on a beanbag with the surgical arm flexed to 90° and suspended over a well-padded post, with joint distraction provided by a weight attached to the hand [61]. Advantages of the lateral decubitus position include improved arm stability, posterior elbow access, and relatively easy airway management [61]. Disadvantages of the lateral decubitus position include orientation challenges from reversed anatomic landmarks and difficult access to the anterior compartment [61]. In the prone position, the arm is suspended off the table in an arm holder with the arm in 90° of shoulder abduction and the elbow in 90° of flexion [61]. Advantages of the prone position include natural traction, easy access to the posterior compartment, and a theoretically increased space between vascular structures and the anterior capsule [61]. Disadvantages of the prone position include the necessity for general anesthesia, difficult airway access, reversed anatomy, and poor access to the anterior compartment [61]. Pressure on the antecubital fossa should be avoided to decrease the risk of injury to anterior neurovascular structures [61].

Adjuncts: A tourniquet is placed as proximal on the arm as possible and can be insufflated as needed [61].

Pain Management: Additional peripheral nerve block combined with a postoperative nerve block catheter in arthroscopic arthrolysis in cases of elbow stiffness may be an opportunity to enhance postoperative outcomes by achieving better functional ROM, perhaps through reduced postoperative pain [66].

Other Considerations: Pediatric elbow arthroscopy performed by an experienced surgeon using a standardized technique for a wide variety of elbow conditions has an acceptable complication rate that is similar to rates in the previously published literature on elbow arthroscopy in the pediatric and adult populations; however, a significant proportion of patients needed subsequent surgery in the following years [15]. A significant proportion of patients from a large cohort of elbow arthroscopy patients visited the ED at least once in the 90 days following surgery [9]. Patients with stiff elbows who underwent arthroscopic arthrolysis achieved satisfactory clinical outcomes very early postoperatively [11]. Overall, patients saw improvement in elbow ROM after arthroscopic elbow capsular release, but many still had residual symptoms from their underlying disease [13].

Complications

Elbow arthroscopy is associated with complications and morbidity despite being a minimally invasive procedure [1]. Systematic reviews of predominantly low-level evidence studies demonstrate varying complication rates after elbow arthroscopy, with a median of 3% and a range of 0%-71% [10]. Reoperation rates after elbow arthroscopy vary, with a median of 2% and a range of 0%-59% [10]. A significant proportion of patients visited the emergency department at least once in the 90 days following elbow arthroscopy [9]. Overall complication rates are lower following arthroscopic approaches compared to open approaches [34]. Elbow arthroscopic surgery is considered a relatively safe procedure with low complication rates [31]. However, elbow arthroscopy has historically been associated with complication rates as high as 20% [58].

Nerve palsy: The most common complication of elbow arthroscopy is neurovascular injury [58]. Neurovascular injury in elbow arthroscopy results from surgeon inexperience, poor technique, and lack of knowledge of elbow anatomy [58]. Insults causing neurovascular injury include compression from cannulas, fluid extravasation into surrounding soft tissues, local anesthesia, and laceration with the scalpel or cannula [58]. Nerve injuries are exceedingly rare in elbow arthroscopy, with reported transient nerve injury rates ranging from 1.7% to 2.0% [58]. Most neurovascular injuries in elbow arthroscopy are transient and resolve without residual deficit [58].

Infection (PJI): Most complications of modern elbow arthroscopy, including wound healing issues and infection, are ubiquitous to arthroscopy of other joints [58]. An increased risk of postoperative infection is noted in patients receiving an intra-articular steroid injection at the end of elbow arthroscopy [58]. Intra-articular steroid injection at the end of elbow arthroscopy is not recommended due to infection risk [58]. Significant increases in postoperative infection risk after arthroscopy of the ankle, knee, hip, shoulder, and elbow are associated with intraoperative intra-articular corticosteroid injection (CSI) administration [72]. Significant increases in postoperative infection risk after arthroscopy of the ankle, knee, hip, shoulder, and elbow are associated with preoperative CSI administration within 4 weeks of surgery [72]. Significant increases in postoperative infection risk after arthroscopy of the ankle, knee, hip, shoulder, and elbow are associated with a BMI >30 [72]. Significant increases in postoperative infection risk after arthroscopy of the ankle, knee, hip, shoulder, and elbow are associated with diabetes [72]. Significant increases in postoperative infection risk after arthroscopy of the ankle, knee, hip, shoulder, and elbow are associated with smoking tobacco [72].

Other Considerations: Pediatric elbow arthroscopy performed by an experienced surgeon using a standardized technique has an acceptable complication rate of 3.7% [15]. A significant proportion of pediatric patients required subsequent surgery in the years following elbow arthroscopy, with a reoperation rate of 12% [15]. Elbow arthroscopic debridement for primary degenerative osteoarthritis is associated with low complication and reoperation rates [23]. No substantial association has been found between complication rate and surgical complexity in elbow arthroscopy, including procedures such as complete synovectomy, radial head resection, osteocapsular arthroplasty, and medial epicondylectomy [58]. Other known complications of elbow arthroscopy include articular cartilage injury, synovial fistula formation, instrument breakage, and tissue injury secondary to the use of a tourniquet [58]. The average mention rate for risk factors across studies reporting complication rates after elbow arthroscopy was 31% [65]. Non-modifiable risk factors are mentioned more often than modifiable ones in studies reporting complication rates after elbow arthroscopy [65]. Life-changing complications such as deep infection and permanent nerve injury do occur in elbow arthroscopy [71]. Improved surgeon training, better understanding of elbow anatomy, and surgical technique standardization have increased the safety of elbow arthroscopy [58]. Surgeons must strive to minimize patient exposure to life-changing complications by mastering indications, anatomy, and technique [71].

Recovery

Complication rates following elbow arthroscopy vary widely, with a median of 3% and a range of 0%-71% [10]. Reoperation rates also vary widely, with a median of 2% and a range of 0%-59% [10]. Arthroscopic approaches are associated with lower overall complication rates compared to open approaches in some cohorts [34].

Light activity (weeks): Patients with stiff elbows undergoing arthroscopic arthrolysis achieved satisfactory clinical outcomes very early postoperatively [11]. Arthroscopic elbow contracture release can improve function and range of motion, although outcomes may vary based on preoperative patient characteristics [29]. Arthroscopic capsular release of the elbow is effective for restoring a functional arc of motion in the short term in most patients with extrinsic contractures [33].

Full activity (months): Patients undergoing arthroscopic elbow capsular release saw improvement in elbow range of motion, but many still had residual symptoms from their underlying disease [13]. Professional baseball players saw an improvement in several performance metrics after elbow arthroscopy [69].

Complete recovery / outcome plateau (months): Systematic reviews demonstrate good mid-term functional outcomes following debridement arthroplasty of the arthritic elbow [35]. Clinical outcomes for patients with primary elbow osteoarthritis undergoing arthroscopic osteocapsular arthroplasty improved from preoperative assessment to short- and medium-term follow-up [64]. Range of motion decreased between short- and medium-term follow-up in patients with primary elbow osteoarthritis who underwent arthroscopic osteocapsular arthroplasty [64].

Key Evidence

  • [L3] Elbow arthroscopy is not without complications and morbidity despite being a minimally invasive procedure and advances made in surgical technique. [1] (10.1177/17585732241249393)
  • [L4] The available evidence supports the use of elbow arthroscopy in the management of the majority of conditions where it is currently used. [2] (10.1016/j.arthro.2011.10.007)
  • [L4] Patients treated arthroscopically benefit from additional diagnostic techniques, improved visualization of the elbow joint, the ability to address coexisting intra-articular pathologic conditions, and minimal soft tissue injury with no clinical consequences in outcomes. [3] (10.1016/j.arthro.2013.08.016)
  • [L5] The purpose of this review is to enable orthopedic surgeons initiating elbow arthroscopy to approach it more safely and easily by describing history, setup, and indications. [4] (10.5397/cise.2023.01032)
  • [L5] Elbow arthroscopy has become a safer and more effective treatment modality for several elbow pathologies due to advances in equipment and surgical technique. [5] (10.5435/00124635-200810000-00003)
  • [L5] Elbow arthroscopy has evolved from a diagnostic tool to a therapeutic procedure with expanded indications, though it requires careful attention to surgical anatomy and patient selection to avoid neurovascular complications. [6] (10.1177/03635465990270022401)
  • [L5] As greater experience is gained and technology advances, arthroscopy will play more of a role in treatment of elbow disorders. [7] (10.1016/j.arthro.2007.08.008)
  • [L4] The majority of the top 50 cited articles in elbow arthroscopy comprised case series exhibiting Level IV or V evidence. [8] (10.1016/j.jisako.2024.04.011)
  • [L3] A significant proportion of patients from a large cohort of elbow arthroscopy patients visited the ED at least once in the 90 days following surgery. [9] (10.1016/j.jseint.2024.03.015)
  • [L4] Predominantly low-level evidence studies demonstrate varying complication rates (median 3%, range 0%-71%) and reoperation rates (median 2%, range 0%-59%) after elbow arthroscopy. [10] (10.1016/j.arthro.2023.04.015)
  • [L1] Patients with stiff elbows who underwent arthroscopic arthrolysis achieved satisfactory clinical outcomes very early postoperatively. [11] (10.1016/j.jse.2024.06.009)
  • [L5] Elbow arthroscopy has expanded indications for diagnosing and treating acute trauma, including radial head fractures and instability, provided patients are carefully selected and neurovascular risks are managed with proper technique. [12] (10.1016/j.hcl.2004.07.003)
  • [L4] Overall, patients saw improvement in elbow ROM, but many still had residual symptoms from their underlying disease after arthroscopic elbow capsular release. [13] (10.1177/23259671231190381)
  • [L5] Recent advances in arthroscopic instrumentation and techniques have led to growing interest in arthroscopic treatment of elbow osteoarthritis. [14] (10.1016/j.jhsa.2017.05.023)
  • [L4] Pediatric elbow arthroscopy performed by an experienced surgeon using a standardized technique for a wide variety of elbow conditions has an acceptable complication rate that is similar to rates in the previously published literature on elbow arthroscopy in the pediatric and adult populations; however, a significant proportion of patients needed subsequent surgery in the following years. [15] (10.1016/j.asmr.2024.100952)
  • [L5] Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint. [16] (10.1016/j.arthro.2024.05.001)
  • [L5] Arthroscopy is emerging as an invaluable tool for diagnosing and treating elbow pathology, offering advantages such as less scarring, decreased risk of infection, and less postoperative pain. [19] (10.1016/j.hcl.2009.05.009)
  • [L5] Elbow arthroscopy has become a valid and safe option for the diagnosis and treatment of both acute and chronic elbow instability, allowing for the management of soft tissue lesions and associated intra-articular bone or cartilage lesions with minimal disruption. [20] (10.1016/j.jseint.2022.12.001)
  • [L1] Elbow arthroscopic debridement for primary degenerative osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes with low complication and reoperation rates. [23] (10.1016/j.arthro.2017.08.247)
  • [L4] Arthroscopic elbow contracture release can improve function and range of motion; however, outcomes may vary based on preoperative patient characteristics. [29] (10.1016/j.jseint.2026.101621)
  • [L1] The results of this study showed that elbow arthroscopic surgery is a relatively safe procedure with low complication rates. [31] (10.1177/23259671221137863)
  • [L4] Among 205 patients who underwent elbow arthroscopy, HO was a minor complication of elbow arthroscopy, with a prevalence rate of 6.3%, and was usually located on the medial compartment of the elbow. [32] (10.1177/03635465231198862)
  • [L5] Arthroscopic capsular release of the elbow is effective for restoring a functional arc of motion in the short term in most patients with extrinsic contractures. [33] (10.5435/00124635-201105000-00004)
  • [L3] Overall rates of complication were lower following arthroscopic approaches in this cohort of surgeons. [34] (10.1177/23259671261425647)
  • [L1] This systematic review demonstrated good mid-term functional outcomes following debridement arthroplasty of the arthritic elbow. [35] (10.1016/j.arthro.2020.09.005)
  • [L4] Serial assessment of patients with primary elbow OA who underwent arthroscopic OCA showed that the clinical outcomes improved from preoperative assessment to short- and medium-term follow-up, although ROM decreased between short- and medium-term follow-up. [64] (10.1177/23259671231162398)
  • [L2] The average mention rate for risk factors across studies reporting complication rates after elbow arthroscopy was 31%, with non-modifiable risk factors mentioned more often than modifiable ones. [65] (10.1016/j.arthro.2024.02.004)
  • [L3] Additional peripheral nerve block combined with a postoperative nerve block catheter in arthroscopic arthrolysis in cases of elbow stiffness may be an opportunity to enhance postoperative outcomes by achieving better functional ROM, perhaps through reduced postoperative pain. [66] (10.1016/j.jseint.2024.10.009)
  • [L4] This surgical guideline describes bedside needle arthroscopy as the initial diagnostic and therapeutic step in the management of patients with suspected bacterial arthritis of a native shoulder, elbow, wrist, knee, and ankle. [67] (10.1016/j.eats.2022.05.011)
  • [L1] Routine diagnostic arthroscopy preceding ulnar collateral ligament reconstruction does not significantly reduce the proportion or rate of subsequent surgery for other valgus extension overload conditions. [68] (10.1016/j.jse.2021.08.004)
  • [L3] After elbow arthroscopy, professional baseball players saw an improvement in several performance metrics. [69] (10.1177/03635465261424876)
  • [L5] Elbow arthroscopy is mostly safe and effective, but life-changing complications such as deep infection and permanent nerve injury do occur; surgeons must strive to minimize patient exposure to these events by mastering indications, anatomy, and technique. [71] (10.1016/j.arthro.2023.06.011)
  • [L3] Significant increases in postoperative infection risk in patients who underwent arthroscopy of the ankle, knee, hip, shoulder, and elbow were noted with intraoperative intra-articular CSI administration or preoperative CSI administration within 4 weeks of surgery, BMI >30, diabetes, and smoking tobacco. [72] (10.1177/03635465261429468)

See Also

References

[1] 30-Day complications, operative time, and overnight admission following elective elbow arthroscopy. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241249393

[2] Evidence‐Based Indications for Elbow Arthroscopy. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2011.10.007

[3] The Role of Arthroscopy in Chronic Elbow Instability. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.08.016

[4] Basic to advanced elbow arthroscopy: the history, basic set up, and indications. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2023.01032

[5] Elbow Arthroscopy. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200810000-00003

[6] Arthroscopy of the Elbow. The American Journal of Sports Medicine. 1999. DOI: 10.1177/03635465990270022401

[7] Elbow Arthroscopy: Where Are We Now?. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.08.008

[8] It is time to move forward: a bibliometric analysis of top 50 cited articles in elbow arthroscopy. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2024.04.011

[9] Emergency department utilization after elbow arthroscopy. JSES International. 2024. DOI: 10.1016/j.jseint.2024.03.015

[10] Wide Range in Complication Rates Following Elbow Arthroscopy in Adult and Pediatric Patients: A Systematic Review. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.04.015

[11] Does tranexamic acid reduce elbow swelling and improve early function following arthroscopic arthrolysis? A double-blind randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.06.009

[12] Arthroscopic management of elbow trauma. Hand Clinics. 2004. DOI: 10.1016/j.hcl.2004.07.003

[13] Incidence of Repeat Elbow Capsular Release After Arthroscopic Elbow Capsular Release. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231190381

[14] Arthroscopic Management of Elbow Osteoarthritis. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.05.023

[15] Pediatric Patients Who Underwent Elbow Arthroscopy Had an 86% Return‐to‐Sport Rate, a 12% Reoperation Rate, and a 3.7% Complication Rate. Arthroscopy, Sports Medicine, and Rehabilitation. 2024. DOI: 10.1016/j.asmr.2024.100952

[16] Elbow Arthroscopy: Pearls to Avoid Nerve Injuries. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.05.001

[17] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Summary and Conclusions.

[18] Aaos Comprehensive Orthopaedic Review 3. Elbow Injuries in the Athlete* > III. Valgus Extension Overload Syndrome and Posterior Impingement.

[19] The Emerging Role of Elbow Arthroscopy in Chronic Use Injuries and Fracture Care. Hand Clinics. 2009. DOI: 10.1016/j.hcl.2009.05.009

[20] The role of arthroscopy in instability of the elbow. JSES International. 2023. DOI: 10.1016/j.jseint.2022.12.001

[23] Arthroscopic Debridement for Primary Degenerative Osteoarthritis of the Elbow Leads to Significant Improvement in Range of Motion and Clinical Outcomes: A Systematic Review. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.247

[24] Orthopaedic Knowledge Update Sports Medicine 6. Magnetic Resonance Imaging of the Elbow > Annotated References.

[28] Aaos Comprehensive Orthopaedic Review 3. Arthritis and Arthroplasty of the Elbow > I. Osteoarthritis.

[29] Preoperative risk factors associated with patient outcomes following arthroscopic elbow contracture release. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101621

[31] Complications of Elbow Arthroscopic Surgery: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221137863

[32] Prevalence, Timing, Locational Distribution, and Risk Factors for Heterotopic Ossification After Elbow Arthroscopy. The American Journal of Sports Medicine. 2023. DOI: 10.1177/03635465231198862

[33] Arthroscopic Management of the Stiff Elbow. American Academy of Orthopaedic Surgeon. 2011. DOI: 10.5435/00124635-201105000-00004

[34] Arthroscopic Versus Open Elbow Debridements Among ABOS Part II Candidates: A Decline in Arthroscopic Volume yet Fewer Complications After Arthroscopic Procedures. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261425647

[35] A Systematic Review of Arthroscopic Versus Open Debridement of the Arthritic Elbow. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.09.005

[36] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Annotated References.

[37] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Anatomy > Bony Anatomy.

[40] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > ELBOW.

[42] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > INJURIES AROUND THE ELBOW.

[44] Aaos Comprehensive Orthopaedic Review 3. Elbow Stiffness* > IV. Evaluation.

[45] Orthopaedic Knowledge Update Sports Medicine 6. Magnetic Resonance Imaging of the Elbow > Introduction.

[50] Green S Operative Hand Surgery. Arthroscopic Release of the Stiff Posttraumatic or Postsurgical Elbow.

[51] Rockwood And Green S Fractures In Adults. 39: Elbow Dislocations and Terrible Triad Injuries > Arthroscopic Excision of Radial Head Fragments: Preoperative Planning Checklist > Open Radial Head Excision: Preoperative Planning Checklist.

[53] Orthopaedic Knowledge Update Sports Medicine 6. Elbow Arthroscopy and the Thrower’s Elbow > Specific Procedures.

[54] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Elbow Degenerative Conditions and Nerve Disorders > Evaluation.

[58] Orthopaedic Knowledge Update Sports Medicine 6. Elbow Arthroscopy and the Thrower’s Elbow > Complications.

[60] Aaos Comprehensive Orthopaedic Review 3. Elbow Injuries in the Athlete* > II. Medial Collateral Ligament Injuries.

[61] Orthopaedic Knowledge Update Sports Medicine 6. Elbow Arthroscopy and the Thrower’s Elbow > Patient Positioning.

[63] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Biomechanics > Clinical Examination.

[64] Serial Changes in Clinical Outcomes After Arthroscopic Osteocapsular Arthroplasty for Primary Elbow Osteoarthritis: A Medium-term Follow-up Study. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231162398

[65] Does Literature on Elbow Arthroscopy Put Complications Into Perspective?. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.02.004

[66] A comparative analysis of short-term results in range of motion following arthroscopic arthrolysis with vs. without peripheral nerve block in cases of elbow stiffness. JSES International. 2025. DOI: 10.1016/j.jseint.2024.10.009

[67] Needle Arthroscopy for Bacterial Arthritis of a Native Joint: Surgical Technique for the Shoulder, Elbow, Wrist, Knee, and Ankle Under Local Anesthesia. Arthroscopy Techniques. 2022. DOI: 10.1016/j.eats.2022.05.011

[68] Routine diagnostic arthroscopy with elbow ulnar collateral ligament reconstruction does not reduce the need for future valgus extension overload–related surgeries: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.08.004

[69] Elbow Arthroscopy and the Risk of Future Ulnar Collateral Ligament Surgery in Professional Baseball Pitchers. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261424876

[71] Editorial Commentary: Avoiding Complications in Elbow Arthroscopy: Know the Indications, Learn the Anatomy, and Master a Safe Technique. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.06.011

[72] Risk Factors for Infection After Ankle, Knee, Hip, Shoulder, or Elbow Arthroscopy: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261429468

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.