Elbow Surgery at OSI
OSI surgeons treat the full range of elbow problems, including distal biceps repair, fracture fixation, and nerve decompression. The right operation is chosen from your diagnosis, imaging, and what you need your arm to do, and your surgeon stays with you through recovery.
Elbow operations are performed at our partner hospitals across the region, with follow-up at any of our six clinic locations. For information on elbow conditions, evaluation, and non-operative treatment, see Elbow Care at OSI, or browse the full list of elbow conditions.
Tendon Repair
Distal biceps repair
Distal biceps repair is one of the more common elbow surgeries we perform. The distal biceps tendon connects the biceps muscle to the forearm bone at the elbow. When it ruptures, typically during a sudden heavy lift or catch, the patient loses significant supination strength (the ability to turn a palm upward, as when using a screwdriver) and a meaningful portion of elbow flexion power.
Timing matters. The retracted tendon begins to scar and shorten within weeks, and surgical repair becomes significantly more difficult after four to six weeks. When a distal biceps rupture is confirmed on exam and MRI, we recommend early surgical repair for active patients who need their arm strength.
The procedure reattaches the torn tendon to the forearm bone through a small incision at the front of the elbow. The tendon is held in place with a small implant while it heals back to the bone. The operation takes about an hour. Recovery involves a hinged brace for four to six weeks while the tendon heals to bone, followed by progressive strengthening. Most patients return to full activity by four months.
Distal triceps repair
Distal triceps repair addresses a rupture of the triceps tendon from its attachment on the bony tip of the elbow. This is a much less common injury than a distal biceps rupture, but it is equally important to fix when it occurs, because the triceps is the primary muscle that straightens the elbow. Without repair, the patient cannot extend the elbow against resistance, which affects pushing, overhead reaching, and getting up from a chair.
The procedure reattaches the tendon to the bone at the tip of the elbow. Recovery follows a similar timeline to distal biceps repair: bracing for four to six weeks, then gradual return to strengthening and full activity over three to four months.
Nerve Surgery
The ulnar nerve runs through a tight channel behind the inner side of the elbow called the cubital tunnel. When the nerve is compressed or irritated in this space, the result is cubital tunnel syndrome: numbness and tingling in the ring and small fingers, hand weakness, and sometimes pain along the inner elbow. It is the second most common nerve compression in the arm, after carpal tunnel syndrome.
Many cases respond to activity modification, nighttime splinting, and nerve-gliding exercises. When conservative measures fail, or when nerve testing shows significant compression, surgery is indicated.
There are two main approaches. One opens the tunnel to give the nerve more room where it already sits. The other moves the nerve to a new position in front of the elbow, away from the area where it is being pinched. Your surgeon chooses based on how compressed the nerve is and what is found at surgery.
Both procedures are performed through an incision on the inner elbow, take roughly 30 to 45 minutes, and are outpatient. Recovery involves a soft dressing and early gentle motion, with most patients returning to desk work within a week or two. Full nerve recovery can take several months, and in cases of prolonged compression, some numbness may be permanent.
Elbow Fracture Surgery
The elbow is a tightly constrained joint with three bones meeting in a small space. Fractures here often affect the joint surface directly and frequently require surgical fixation to restore alignment and allow early motion. A stiff elbow is a poorly functioning elbow, so the goal of fracture surgery is anatomic reduction and stable fixation that permits rehabilitation to begin early.
Radial head fractures
Radial head fractures are the most common elbow fracture in adults, typically caused by a fall onto an outstretched hand. Simple fractures that stay in place heal with early motion and no surgery. Fractures knocked out of place that block rotation require fixation with screws or a small plate. When the top of the forearm bone is shattered beyond repair, it is replaced with a metal implant, which keeps the elbow and forearm stable.
Olecranon fractures
Olecranon fractures break the bony prominence at the tip of the elbow. Because the triceps tendon attaches here, a displaced olecranon fracture means the patient cannot actively extend the elbow. Surgical fixation uses a plate and screws or tension-band wiring to restore the joint surface and reestablish triceps function. Early motion begins within a few days of surgery.
Coronoid fractures
Coronoid fractures involve the bony projection at the front of the forearm bone that acts as a buttress against backward dislocation of the elbow. Coronoid fractures rarely occur in isolation. They are most often part of a complex injury pattern involving ligament damage or other fractures. Surgical fixation restores this important stabilizer and is performed at the same time as repair of the other injured structures.
Distal humerus fractures
Distal humerus fractures involve the lower end of the upper arm bone where it forms the elbow joint. These are complex injuries that often break the joint surface into several pieces. Surgery to realign the bone and hold it with plates and screws is the standard treatment, rebuilding the joint surface and allowing early motion. In older patients with badly shattered fractures and weaker bone, elbow replacement may be a more reliable option than trying to rebuild a shattered joint surface.
Terrible triad injury
The terrible triad is a combined injury pattern involving elbow dislocation, radial head fracture, and coronoid fracture. It earned its name because the combination creates a highly unstable elbow that is prone to re-dislocation and stiffness. Surgical treatment addresses all three components: the radial head is fixed or replaced, the coronoid is repaired, and the torn ligaments on the outer side of the elbow are rebuilt. This is one of the more technically demanding elbow operations, and the rehabilitation protocol is carefully structured to balance stability with early motion.
For the full picture on fracture care across all regions, see Fracture & Trauma Care at OSI.
All Elbow Procedures We Perform
Tendon repair
Fracture fixation
What Surgery Day Looks Like
Most elbow surgery is outpatient: you come in, have the procedure, and go home the same day, usually in a splint or sling. Many procedures are done under a regional block placed by the anesthesiologist, where only the arm is numbed, with sedation so you are comfortable. You leave with written instructions, splint rules, and a plan for the first follow-up visit. Someone needs to drive you home.
Recovery and What to Expect
Recovery timelines vary by procedure and by patient. A distal biceps repair patient wears a hinged brace for four to six weeks, begins gentle active motion around six weeks, and returns to full lifting by four months. Cubital tunnel release patients begin moving the elbow within days and return to most activities within two to four weeks, though nerve recovery itself continues for months. Fracture fixation patients typically begin supervised motion within the first week after surgery to prevent stiffness, with progressive strengthening over the following two to three months.
The elbow is particularly prone to stiffness after injury or surgery. For this reason, early motion is a priority in nearly every elbow rehabilitation protocol. Your surgeon will give you specific motion goals and restrictions for each phase of recovery, and physical therapy is essential to regaining a functional arc of motion. Pushing too hard can cause problems, while waiting too long risks permanent stiffness. The balance between protection and motion is where experienced rehabilitation makes the difference.
Who You Will See Here
All three of our board-certified orthopedic surgeons perform elbow surgery. Meet our providers.
