Elbow pain can have causes that aren’t due to underlying disease. Examples include prolonged pressure or leaning on elbows, trying a new exercise such as tennis, local trauma, desk work, sprains, or strains.

Meet Our Doctors Who Treat the Elbow

Edward J. Bieber, MD

Edward J. Bieber, MD

Orthopedic Hand, Wrist, Elbow and Shoulder Surgeon

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Craig A. Miller, MD

Craig A. Miller, MD

Orthopedic Shoulder, Elbow & Knee Surgeon

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Mahidhar M. Durbhakula, MD

Mahidhar M. Durbhakula, MD

Orthopedic Hand, Wrist and Elbow Surgeon

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Elbow Conditions and Treatments

The elbow is a hinge joint consisting of three bones. The upper part of the hinge is at the end of the upper arm bone (humerus), and the lower part of the hinge is at the top of the two forearm bones (radius and ulna) which are side by side. When the elbow is bent, the ends of the two forearm bones rub against the end of the humerus.


Your Elbow Surgery

The elbow is a hinge joint consisting of three bones. The upper part of the hinge is at the end of the upper arm bone (humerus), and the lower part of the hinge is at the top of the two forearm bones (radius and ulna) which are side by side. When the elbow is bent, the ends of the two forearm bones rub against the end of the humerus.

Bones of Elbow Joint

elbow joint diagram

In a healthy elbow joint, the surfaces of these bones are very smooth and covered with a tough protective tissue called cartilage. Arthritis causes damage to the bone surfaces and cartilage where the three bones rub together. These damaged surfaces eventually become painful.

Arthritic Elbow Joint Surfaces

arthritic elbow joint diagram

There are many ways to treat the pain caused by arthritis. One way is total elbow replacement surgery. The decision to have total elbow replacement surgery should be made very carefully after consulting your doctor and learning as much as you can about the elbow joint, arthritis, and the surgery.

In total elbow replacement surgery, an artificial hinge made of metal and a very durable plastic material is inserted into the joint so that the elbow can move without allowing the two forearm bones to contact the humerus. We call this artificial hinge an “implant.”

Getting to the Joint

The patient is first taken into the operating room and given anesthesia. After the anesthesia has taken effect, the skin around the elbow is thoroughly scrubbed and sterilized with an antiseptic liquid. A tourniquet is then applied to the upper portion of the arm to help slow the flow of blood.

An incision about six inches long is then made over the elbow joint. The incision is gradually made deeper through muscle and other tissue until the bones of the elbow joint are exposed.

Preparing the Bones

One of the forearm bones, the ulna, has a projection at the end, which extends up and behind the end of the humerus. A special power saw is used to remove part of this projection

A second purpose of the preoperative therapy visit is to prepare you for your upcoming surgery. You will begin to practice some of the exercises you will use just after surgery. You will also be trained in the use of either a walker or crutches. Whether the surgeon uses a cemented or noncemented approach may determine how much weight you will be able to apply through your foot while walking.

This allows the two forearm bones to be rotated out of the way so parts of the humerus can be removed with the saw. Precision guides are used to help make sure that the cuts are made so the bones will align properly after the implant is inserted.
The middle portion at the end of the humerus is removed first.

The arm bones have relatively soft, porous bone tissue in the center. This part of the bone is called the “canal.” Special instruments are used to clear some of this soft bone from the canal of the humerus. These instruments also help shape the canal to fit the shape of the implant

Then, similar instruments are used to clear some of the soft bone and shape the canal of the ulna.

Attaching the Implants

The elbow implant consists of two metal stems that are connected by a metal locking pin. This pin passes through the ends of both stems, which are lined with a strong plastic material, serving as a bearing that allows the elbow to bend. The stems are inserted into each of the two prepared canals. A special kind of cement for bones is first injected into the canals to help hold the stems in place

When the cement is hard, the two implant parts are brought together and the pin is inserted to connect them.

Closing the Wound

If necessary, the surgeon may adjust the ligaments that surround the elbow to achieve the best possible elbow function.

When all of the implants are in place and the ligaments are properly adjusted, the surgeon sews the layers of tissue back into their proper position. A plastic tube may be inserted into the wound to allow liquids to drain from the site during the first few hours after surgery. The edges of the skin are then sewn together, and the elbow is wrapped in a sterile bandage. Finally, the patient is taken to the recovery room.

Dr. Feuchtbaum Testimonial

Dear Dr. Feuchtbaum, Thank you so much for a successful surgery today. The whole experience from start to finish was as easy and comfortable as it could ever be and every person I encountered was amazing. I especially appreciate you taking time to talk with me and visiting me after – I remember most of it!

- J.L.  

Physical Therapy Testimonial

“My wife is near the last phases of her Physical Therapy with OrthoBethesda. She broke her left humerus in October 2016, had a total shoulder arthroplasty with Dr. Bieber, and started her therapy with you almost immediately. She has done exceptionally well in her recovery and this is due to orthoBethesda’s fine care and wonderful caring people in all aspects of the PT operation. Being…

- D.M.  

Dr. O'Brien Testimonial

Dr. O’Brien, Just a quick note to again thank you very much for the terrific surgery you performed on my back this past [month]. I feel confident that you have put me back on the road to good back health. I truly appreciate your time and effort and for your being able to do everything that you did for me.

- C. H.  

Dr. O'Brien Testimonial

Dr. O’Brien – I just returned from our family trip to Kenya…I wanted to personally thank you for making it possible for me to take this trip of a life time with my children and grandchildren. It was, at times, physically demanding with the very bumpy jeep rides—climbing up and down — and 16 hours of flying to and from Nairobi. My back was 100%…

- S. W.  

Dr. Fisch Testimonial

Dr. Fisch, thank you for your understanding, your compassion, your sense of humor, and for not giving up on me. I trust your abilities, your communication and for the many years now I trust in the confidence you instill in me. It all gives me the strength to deal with “whatever” challenges I need to accept and accommodate in my life. I admit that presently…

- M.W.  

Dr. Gazdag Testimonial

I broke my 5th metatarsal on a Monday night and woke up the next day and called OrthoBethesda for an appointment. Although Dr. Gazdag was fully booked for the day, he squeezed me in and told me to pass by in 45 minutes for an X-ray and evaluation. I thought that was pretty awesome! I am so impressed with Dr. Gazdag. He has handled my…

- P. M. 05/23/2019

Physical Therapy Testimonial

Service was great Zed is terrific PT. My second time using him.

- W. H.  

Dr. Fisch Testimonial

Dr. Fisch, where to even start? When I despairingly stumbled into your office on 11/19/18 for my initial appointment… my search for a doctor who actually listened to my symptoms and showed an interest in finding out the root cause of my neck, arm, and hand pain was over! I was totally exasperatedly pushing through life with pain and this agonizing journey had been an…

- S. G.  

Dr. O'Brien Testimonial

I’m going to start by saying that Dr. O’Brien has given me my life back. I started having problems about 7 months ago. Initially, it was back pain but it quickly progressed to a horrible nerve, groin, and buttock pain on the right side. I saw one neurosurgeon who suggested epidurals. 4 epidurals and one diagnostic block later, my symptoms were only getting worse. My…

- M.B.  

Dr. O'Brien Testimonial

Late last year, I was told I would need knee surgery. I visited Dr. O’Brien, and he examined the MRI and concluded that all I needed was PT. He was right! I had one steroid injection and PT and now walk 5 miles with no knee problems. THANK YOU for your good advice and a conservative approach. You are seriously good!

- R.E.  

Hand Therapy Testimonial

I would like to extend my compliments to the staff at OrthoBethesda. I am a patient of Dr. Bieber (have been for over 30 years…). at the end of June, I fell on my right hand and repeated it in a much more dramatic way at the end of July. In both cases and with the guidance of Dr. Bieber I had the good fortune…

- R.E.  

Dr. O'Brien Testimonial

Dr. O’Brien, Upon a short time ago, I realized that I did not give you a complete or accurate report of how I was feeling, because I had not stood up yet. Because I had focused on that, the fact that I slept through the night without waking up with the stabbing pain on my spinal cord. I slept through the night for the first…

- J.R.  

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Contact OrthoBethesda Today!

Whether you’ve received a referral from your primary care physician or would like to visit our premier team to discuss any orthopedic issues you may be experiencing, we invite you to contact us today. Patients in Bethesda, MD, Arlington, VA, and beyond can give us a call at (301) 530-1010.