Q: My surgeon wants to do an arthroscopic exam on my elbow to find out what's wrong. I know this is supposed to be a simple procedure. But I seem to be the kind of person where nothing is ever very simple. Can you tell me more about what to expect?
A: Elbow arthroscopy is a surgical technique used routinely now for the evaluation and treatment of many elbow problems. Since the first arthroscopic elbow treatment became available, the ways and reasons to use this tool have expanded. Now surgeons use it to clean the joint out from any infection, remove any loose bodies (fragments of bone, soft tissue, cartilage), and repair defects (holes or other lesions) in the bone.
Some patients can't be treated with arthroscopy but require an open incision instead. Anyone with abnormal or distorted anatomy and anyone with severe heterotopic ossification (bone formation in the soft tissues). Patients with burns or who have skin grafts are not good candidates for this type of procedure because of the danger of damage to the nerves and blood vessels.
The procedure itself is usually done with the patient under general anesthesia. The patient will be relaxed and comfortable. If there is concern for postoperative nausea from the anesthesia, then a regional anesthesia (just the arm is numbed) can be used. Using a nerve block like this has one major disadvantage. The surgical staff cannot assess the patient's neurologic status for quite some time after surgery (until the nerve block wears off).
Careful patient positioning is important to give the surgeon the best view inside and around the joint. Depending on the procedure, you may be supine (on your back) with the arm suspended by traction or prone (face down) with the arm hanging off the table in a special arm holder. There are advantages and disadvantages of each position your surgeon can discuss with you if you are interested in those details.
Though elbow arthroscopy is a well-used procedure now, it still takes expertise and experience on the part of the surgeon to be successful. There are many factors to take into consideration including knowledge of the elbow anatomy and correct patient positioning. Inserting the scope into the joint also requires careful selection of placement to avoid complications.
As you might guess from what has been said already, the most commonly reported complication is nerve injury. Damage to the nerve usually results in a temporary neurologic injury but sometimes the nerve gets cut completely. This is more likely to cause permanent damage. Infection and damage to the soft tissues are the other most common problems surgeons must try and avoid. Good surgical technique and proper portal placement go a long way in preventing complications.
Reference: J. Michael Bennett, MD. Elbow Arthroscopy: The Basics. In The Journal of Hand Surgery. January 2013. Vol. 38A. No. 1. Pp. 164-167.
Can you tell me what to expect with an elbow arthroscopic exam?
