Elbow arthroscopy is an operational method that enables the minimally invasive diagnostics and treatment of injuries and illnesses of elbows. Operation is conducted under general anesthesia. As in arthroscopy of other joints, in elbow arthroscopy we also apply the optic endoscope in the joint through a small skin incision. The camera on the endoscope transmits an enlarged picture of the joint interior on the screen and in this way allows the surgeon to fully examine all the anatomical structures within the joint and directly beside the joint.
Elbow arthroscopy is due to the closeness of many nerves and blood vessels, which take place directly beside the joint, technically a very demanding procedure, but with the appropriate level of expertise of the operator is safe, and has many advantages over traditional surgery. Elbow arthroscopy was widely established only in recent years. The most commonly used is in the treatment of tennis elbow, early degenerative changes, cartilage injuries, posterolateral plica, some forms of joint instability, chronic contractures in the elbow and chronic synovitis, which is usually present in rheumatoid arthritis of elbow.
Procedure of elbow arthroscopy
Elbow arthroscopy is a surgical procedure which is carried out under general anesthesia. To carry out a diagnostic arthroscopy, four skin incisions, each 0.5-1 cm in length, are needed. Through the first two, we examine the front of the elbow joint with the camera and sensor. In the second part of the diagnostic arthroscopy, through the other skin incisions, we apply two cameras and sensors in the back of the elbow joint. Similar to knee arthroscopy, also the elbow joint is during surgery filled with sterile saline. It is a solution of NaCl, which flushes out joint, expands it a bit and in this way provides a good visibility inside the joint.
Elbow arthroscopy is carried out usually in two steps. In the first part of the procedure we apply the arthroscope in front of the the joint and examine the front surface of humerus, anterior joint membrane, and the joint of the radius and upper arm. We continue the arthroscopy with examining the fossa in the posterior part of the elbow, and the posterior part of the joint surface of the humerus, radius and forearm. During such diagnostic examination of the joint we can discover degenerative or injury changes in the cartilage surfaces of the joint, loose bodies in the joint, bone spurs due to advanced degenerative changes, thickening of the joint membrane, pathologically modified synovial membrane and signs of instability with looseness of ligaments.
During the elbow arthroscopy, depending on the type of injury or illness, we perform the planned surgery. In that way we can treat the initial degenerative changes in the joint with smoothing its surfaces, limited range of motion of the joint with releasing over-thickened joint membrane, chronic joint swelling in the context of rheumatic diseases by removing the synovial membrane, problems associated with epicondylitis with the removal of defective radial extensor tendon, removing loose bodies in the joint, and some other conditions. Given the extensiveness and complexity of the procedure, the operation time varies from 20 minutes to two hours. After the procedure, the patient has to rest for a shorter period of time in the recovery room and he is released home on the same day.
The advantages of arthroscopic procedures on elbow joint
Arthroscopic surgical techniques, which allow minimally invasive treatment of injuries and illnesses of the joints, have several advantages over traditional surgery. In the elbow joint, the arthroscopy allows us a complete examination of the whole joint, and shows us many anatomical structures that can not be analyzed in the conventional surgery.
Maintaining the integrity of muscles around the joint in arthroscopic surgery is associated with minor pain in the postoperative period, no scarring and adhesions, which may otherwise occur between the muscles and joint membrane. Arthroscopic elbow surgery has also a significantly lower risk of postoperative surface or deep infections, and lower risk of excessive bleeding. Finally, the small skin cuts also significantly decrease the risk of postoperative infection on the surface and inside the joint, also the risk of excessive bleeding is lower. Finally, due to the small skin cuts, the cosmetic effect of the operation is also significantly better.
Indications of shoulder arthroscopy
• Chronic synovitis with joint swelling
• epicondylitis (tennis elbow)
• Limited range of motion of the elbow
• Moderate degenerative changes
• Problems associated with the radial plica
• problems associated with radius surface
• loose bodies in the joint
• Reduced damage of cartilage surface
• Unexplained joint pain
Recovery after elbow arthroscopy
Due to minimal invasiveness, recovery from arthroscopic surgery is in many ways much faster and easier than after conventional surgery. After these types of operations, there is less pain, in some cases also the joint function is regained quicker. The actual recovery time depends on the type of performed procedure and is relatively short in simple surgeries, such as removal of loose body parts or soothing degenerative bone changes on the edges of joint surface.
The rehabilitation is longer after more demanding operations like joint synovectomy, tennis elbow surgery, or the release of thickened joint membrane with smoothing the joint surface as part of treatment from moderate to advanced degenerative changes in the elbow joint. Rehabilitation after such surgery usually takes 4-6 months. The patient also needs to know that when the degenerative changes are already present in the joint, they contribute to a substantial extension of the rehabilitation process, and they affect the less favorable result of such treatment. Immediately after the operation, it is necessary to cool the elbow with ice several times a day, which reduces swelling and joint pain. On discharge, the patient is be prescribed adequate analgesic therapy and he also receives instructions on the permitted activities of the operated arm. In the first few days after surgery, it is generally recommended to rest the arm. After soothing the pain, the patient can gradually begin to use his arm at everyday tasks. At the second medical examination, after the surgery, an individualized program of physical therapy, which is adapted to the individual and the type of surgical procedure performed, is prescribed.