Elbow Arthroscopy Overview
What Is Arthroscopy?
Arthroscopy is a minimally invasive surgical procedure that allows orthopaedic surgeons to diagnose and treat joint problems.
The term “arthroscopy” is derived from the Greek words “arthro” (joint) and “skopein” (to look), meaning “to look within the joint.” During an elbow arthroscopy:
- A small camera called an arthroscope is inserted into the elbow joint.
- The camera projects images onto a monitor, allowing the surgeon to guide thin, specialized surgical instruments.
This approach requires small incisions, resulting in:
- Reduced pain.
- Less joint stiffness.
- Faster recovery compared to open surgery.
Elbow arthroscopy has been performed since the 1980s and continues to evolve with advancements in instruments and techniques, making it safer and more effective.
Elbow Anatomy
The elbow is a complex joint formed by three bones:
- Humerus: Upper arm bone.
- Ulna: Forearm bone on the pinky side.
- Radius: Forearm bone on the thumb side.
Key components of the elbow joint include:
- Articular Cartilage: Covers the bone surfaces where they meet, providing a smooth, cushioned interface.
- Synovial Membrane: Produces lubricating fluid to minimize friction during movement.
- Collateral Ligaments: Located on the inner and outer sides of the elbow, these ligaments stabilize the joint and prevent dislocation.
- Surrounding Muscles: Facilitate elbow movement and stability.
- Major Nerves: Three nerves cross the elbow joint, requiring careful protection during arthroscopic surgery.
Movements of the Elbow Joint
The elbow enables two primary movements:
- Bending and Straightening (Flexion and Extension): Occurs at the joint between the humerus and ulna.
- Forearm Rotation (Pronation and Supination):
- Pronation: Palm facing down.
- Supination: Palm facing up.
Rotation occurs at the joint between the ulna and radius and is influenced by muscles and ligaments extending to the wrist.
By preserving the integrity of these components, elbow arthroscopy allows for precise diagnosis and treatment of joint issues, enhancing recovery and functionality.
When Is Elbow Arthroscopy Recommended?
Conditions Treated with Elbow Arthroscopy
Elbow arthroscopy is often recommended for painful conditions that do not respond to nonsurgical treatments such as:
- Rest
- Physical therapy
- Medications or injections: These reduce inflammation, which can cause swelling, pain, and stiffness in the elbow.
Most elbow issues arise from:
- Injury
- Overuse
- Inflammatory conditions (e.g., rheumatoid arthritis)
- Age-related wear and tear
Common Uses of Elbow Arthroscopy
Elbow arthroscopy can address various conditions that damage cartilage and soft tissues in the joint. It may be recommended to:
- Treat Tennis Elbow (Lateral Epicondylitis): Relieves pain and restores function.
- Remove Loose Bodies: Removes loose cartilage or bone fragments causing discomfort.
- Release Scar Tissue and Bone Spurs: Improves range of motion by removing obstructions.
- Treat Osteoarthritis: Eases symptoms of wear-and-tear arthritis.
- Treat Rheumatoid Arthritis: Reduces inflammation and pain caused by this autoimmune condition.
- Address Osteochondritis Dissecans: Repairs damage to the humerus (capitellum) seen in activities like throwing or gymnastics.
- Treat Some Fractures: Helps manage certain types of elbow fractures.
Elbow arthroscopy provides a minimally invasive solution for various conditions, helping to alleviate pain and improve joint function when conservative treatments are insufficient.
This X-ray of an elbow taken from the side shows severe osteoarthritis. Note the large bone spurs that have formed around the joint. During an arthroscopic procedure, these bone spurs can be removed, along with any loose fragments of cartilage.
When Open Surgery is More Effective
While elbow arthroscopy is a valuable tool for many conditions, certain procedures are more effective when performed as open, traditional surgeries. These include:
- Treating Golfer’s Elbow (Medial Epicondylitis): Open surgery offers better access to repair tendons affected by this condition.
- Repairing Collateral Ligaments: Essential for restoring joint stability.
- Fixing Certain Types of Fractures: Open techniques are often required for precise realignment and stabilization.
- Elbow Joint Replacement (Arthroplasty): This procedure is best performed through an open approach for proper placement of the joint prosthesis.
- Cubital Tunnel Release: Decompresses the ulnar nerve (funny bone nerve) to relieve symptoms of numbness or weakness.
Combining Arthroscopic and Open Techniques
In some advanced cases, surgeons may combine arthroscopic and open techniques in a single procedure. For example:
- In severe osteochondritis dissecans, the loose bone fragment may be removed arthroscopically, while the damaged area of the humerus is repaired with a bone graft through an open technique.
By using the most effective surgical approach for each condition, surgeons can ensure the best outcomes for patients while addressing complex elbow issues.
Planning for Elbow Arthroscopy
Evaluations and Pre-Surgery Tests
Before your surgery, your orthopaedic surgeon may recommend:
- A visit to your primary care doctor to address any medical conditions.
- Routine tests such as blood tests, an electrocardiogram, or a chest X-ray to ensure your safety during surgery.
For patients with specific health risks, a more detailed evaluation may be necessary.
Important Note: Inform your surgeon about all medications and supplements you take, as some may need to be stopped before the procedure.
Outpatient vs. Hospital Stay
- Most elbow arthroscopies are performed as outpatient procedures, allowing you to return home the same day.
- For certain complex procedures, a hospital stay may be recommended for close monitoring, therapy, or pain management. Your surgeon will advise if this is necessary.
Anesthesia Options
Elbow arthroscopy may be performed under:
- General Anesthesia: You will be asleep with a breathing tube.
- Regional Nerve Block: Numbs your arm while you remain awake.
- Combination of Both: Provides comprehensive pain control.
In some cases, the regional nerve block is administered post-surgery in the recovery room, allowing your surgeon to confirm proper nerve function and rule out any nerve injury.
Surgical Procedure and Positioning
- Preparation:
- General anesthesia is administered.
- Intravenous antibiotics are given before surgery to reduce the risk of infection.
- Positioning:
You will be positioned to provide the surgeon with optimal access to your elbow joint. Common positions include:- Lateral Decubitus: Lying on your side.
- Prone: Lying on your stomach.
- Supine: Lying on your back (less common, based on surgeon preference).
- Care During Positioning:
The surgical team ensures your spine and pressure points in your arms and legs are properly protected and padded for safety and comfort.
By following these steps, your surgical team ensures the procedure is conducted safely and effectively, maximizing the chances of a successful outcome.
Elbow Arthroscopy Procedure
Step-by-Step Procedure
- Joint Preparation
- The surgeon fills the elbow joint with fluid to improve visibility and reduce the risk of injury to surrounding blood vessels and nerves.
- This fluid creates a clearer view of the joint structures through the arthroscope.
- Incisions and Arthroscope Insertion
- Several small incisions (cuts) are made to insert the arthroscope and surgical instruments.
- Fluid continuously flows through the arthroscope to maintain a clear view and control bleeding.
- Images from the arthroscope are displayed on a video screen, allowing the surgeon to see inside the elbow joint in detail.
- Joint Evaluation
- Before specific treatments begin, the surgeon evaluates the joint thoroughly.
- If needed, additional small incisions (up to 5-7) may be made to assess the entire joint.
- Specialized Instruments
- Using thin, specialized tools, the surgeon performs various tasks, such as:
- Shaving damaged tissue.
- Cutting or removing problematic structures.
- Grasping loose fragments.
- Suture Passing and Knot Tying: Securing soft tissues.
- In some cases, special devices are used to anchor stitches into the bone for stability.
- Using thin, specialized tools, the surgeon performs various tasks, such as:
This minimally invasive approach allows the surgeon to diagnose and treat elbow problems with precision, resulting in reduced recovery time and minimized risks compared to open surgery.
