Elbow Arthroscopy

What is Elbow arthroscopy?

Elbow arthroscopy is a surgical procedure that is marked by treatment of elbow conditions through small incisions on the skin. This procedure makes it convenient for the surgeons to look into the elbow with the help of a small camera. The camera displays the picture of the elbow and its contents on a television screen, which guides the surgeon to use miniature surgical instruments. It is a widely used surgical procedure to treat elbow ailments. It is better than open surgery as it involves a minimal incision on the skin leading to a speedy recovery with minimal complication rates.

 

What are the Indications for the procedure?

Elbow arthroscopy is done when there is a need for treatment for –

  • Removal of loose body
  • Debridement of osteophytes or bony projections
  • Debridement for septic arthritis
  • Elbow fractures
  • Stiffness in the elbow
  • Tennis elbow
  • Rheumatoid arthritis
  • Osteoarthritis

 

What are the benefits?

The benefits of this operation are-

  • It is a minimally invasive procedure that means it allows quick access to the affected part with minimum damage to the neighbouring tissues.
  • It improves the stiffness in the affected elbow.
  • It increases the range of motion.
  • It helps in faster recovery than open surgeries.
  • Less blood loss
  • Less painful

 

What are the risks?

Although elbow arthroscopy is a safe procedure and it has its own risks. The risks increase with the complexity of the problem/surgery.

  • Damage to neighbouring nerves (1-5%)
  • Infection (<1%)
  • Damage to blood vessels (<1%)
  • Stiffness in the elbow (1to 2 %)
  • Recurrence of symptoms
  • Complex regional pain syndrome (very rare about 1 in every 3000 cases)

 

How should I prepare for the procedure?

  1. Before surgery, your surgeon will investigate your general condition through certain tests such as blood tests, electrocardiogram or chest X-ray to rule out any health risks. This helps to rule out any possible risks of surgery such as bleeding, heart diseases etc.
  2. It is advisable to inform your surgeon about any medications or supplements (esp. Blood thinners) you are taking. He may ask you to stop them before the surgery as they may complicate the operation.
  3. If you are a smoker, you should stop smoking at least 48 hours before the operation. Smoking increases the risk of chest and wound infection. It also affects your recovery process after the surgery by slowing it down. Some patients require help for household activities as many activities that require upper movement of the shoulder and other household activities such as bathing, dressing, laundry and cooking for few weeks nearly six weeks.
  4. Any infection in the body including common cold or a cough should be cleared up before the operation.
  5. You should also stop eating or drinking 8 hours before the operation.
  6. Positive attitude towards the operation and your condition are necessary for the success of the surgery. This will help you for better health benefits and faster recovery.

 

How is it performed?

  • Surgery is performed as a day case after assessment of your general health. You are likely to be discharged on the same day.
  • The operation is performed under general anaesthesia or local anaesthesia (Block). In general anaesthesia, the patient does not feel anything and sleeps throughout the operation. In local anaesthesia, the patient remains awake during the operation but he cannot feel whatever is happening in the surgical area. Your anaesthetist can select a combination of both local and general anaesthetic.
  • Positioning- once you are given anaesthesia, your surgeon will give you antibiotics to reduce any risk of infection after surgery. You are positioned in lateral decubitus (on your side) position with the affected arm facing upwards.
  • A tourniquet is tied around your upper arm and the arm is placed in an arm holder to keep the arm in its proper position during the entire operation. The shoulder and upper body are wrapped in sterile surgical drapes.
  • Procedure– lines are drawn on the skin of elbow to mark certain structures and incision and placements of an arthroscope. Fluid is filled in the elbow to have a clear vision of the structures of elbow through the arthroscope. This reduces the risk of injuries to blood vessels and nerves. Small cuts are made on the markings. The arthroscope (a wire that has a camera on one end) is introduced from one of the cuts and small instruments from the rest of the cuts. These instruments are used for cutting, shaving, grasping, passing sutures and tying knots during the operation. Special devices are introduced to anchor stitches into the bone. The damaged parts are repaired, and completely damaged parts are removed. Tendon grafts or bone substitutes may be used according to the need. After repairing, the incisions or cuts are closed with absorbable sutures.
  • The operation usually ends in an hour or two.

 

What happens after surgery?

  • The anaesthetics wears off in 4-10 hours after the surgery; the patient is encouraged to take painkillers before they can experience pain. This blocks the sensation of pain and discomfort caused by the operation. Thus, most patients report no or little pain.
  • A sling is applied on the elbow in order to give rest to the joint and avoid any further injury to the joint and the patient is discharged on the same day..
  • You can apply ice to relieve pain and you have to keep the elbow slightly elevated to avoid swelling.
  • Before discharge, you may see a physiotherapist, who will teach you gentle exercises of your shoulder, elbow, fingers and wrist. You may be able to start these gentle exercises on the day of your operation and they are essential to reduce stiffness and pain.
  • The bulky bandage could be removed in 24-48 hrs and you will have small dressings covering the key hole wounds.
  • You can use your arm to do light activities (writing, using keyboard etc) that don’t cause excessive pain or discomfort. This will be advised by your surgeon and physiotherapists.
  • The patient is reviewed in clinic around 2 weeks following the operation for wound check and physiotherapy.
  • The wound should be massaged (typically after 2 weeks) using the moisturizing cream by the patient 3 times a day for 3 months once the wound is well healed. This reduces the scar sensitivity and scar-related complications (tenderness; helps scar to mature).
  • You could start gentle range of movement (ROM) exercises at 3 weeks and progress to more strenuous activities around six weeks. This will be guided by your surgeon and is based on clinical and radiographic assessment. It is advisable to avoid any injury to the affected area for 3 months. The duration may increase or decrease based on the complexity of primary problem.

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