Elbow arthroscopy has been performed since the 1980s. The word “arthroscopy” is derived from two Greek words: “arthro” (joint) and “skopein” (to look). Arthroscopy literally means “to look within the joint.” Dr. Stowell uses arthroscopy to visualize and treat problems inside a joint. During elbow arthroscopy, Dr. Stowell inserts a small camera, called an arthroscope, into your elbow joint. The camera then displays images on a television screen so that Dr. Stowell can use these images to guide his small surgical instruments. Since the surgical instruments used in arthroscopy are small, Dr. Stowell can use very small incisions for surgery. This results in less pain, less joint stiffness, and many times, shortens the patient’s recovery time.
Dr. Stowell may recommend elbow arthroscopy if your elbow condition is not responding to nonsurgical treatment, which includes rest, physical therapy, medications, and/or steroid injections that can reduce inflammation. Inflammation is our body’s natural response to injury or disease. In an injured or diseased elbow, swelling, pain and stiffness can result from inflammation.
Most elbow problems are caused by traumatic injury, overuse, and age-related wear and tear. Elbow arthroscopy may help relieve painful symptoms and release scar tissue that may be blocking motion. Elbow conditions that may benefit from elbow arthroscopy include:
- Tennis elbow (lateral epicondylitis)
- Removal of loose bodies (cartilage and bone fragments)
- Release of scar tissue for better range of motion
- Rheumatoid arthritis
- Osteochondritis dissecans (commonly seen in gymnasts or throwers)
Some elbow conditions are most effectively treated using traditional, open surgical procedures such as:
- Golfer’s elbow (medial epicondylitis)
- Repairing collateral ligaments
- Some types of fractures
- Elbow joint replacements (arthroplasty)
- Ulnar nerve decompression (funny bone nerve)
In some advanced surgeries, traditional, open surgical treatments may be used in conjunction with arthroscopy in the same setting. For example, in severe osteochondritis dissecans, a loose piece of bone may be removed arthroscopically while the damaged humerus may be treated with a bone graft using open surgery.
Planning for Surgery
Dr. Stowell may advise you to see your primary care doctor to make sure that you do not have any medical problems that need to be addressed before your surgery. X-rays, blood tests, an electrocardiogram may be needed in order to safely perform your surgery. You will need to inform Dr. Stowell of any medications or supplements that you take. He may advise that you stop taking some of them before surgery.
If you are generally healthy, your arthroscopy will likely be outpatient, which means you will not need to stay overnight at the hospital. The surgery center will contact you ahead of time to provide specific details about your procedure and give you instructions about how to prepare for your surgery. Make sure you follow the instructions on when to arrive, especially when to stop eating or drinking prior to surgery.
Before your surgery, the anesthesiologist will discuss your anesthesia options. Elbow arthroscopy is usually performed using general anesthesia, which means you will be put to sleep. Intravenous antibiotics are also administered, typically before surgery, to lessen the risk of infection after surgery.
Regional nerve block injections are rarely used because the numbing effects can last for hours after surgery, which prevents Dr. Stowell from completing a careful nerve examination in the recovery room. He will make sure that the nerves that travel down your arm are functioning well. For pain, if necessary, a regional anesthetic may be given after Dr. Stowell completes your nerve examination.
Once you are in the operating room, you will be positioned so that Dr. Stowell can easily adjust the arthroscope to have a clear view of your elbow. The two most common positions for elbow arthroscopy are lateral decubitus (side lying) and prone (lying on your stomach). Your spine and other pressure points are carefully padded and supported to protect positioning.
Next, a tourniquet is applied to your upper arm, which is then placed into an arm holder to keep it in place during surgery. Your shoulder and upper body will be covered with sterile surgical drapes and the surgical team will clean your skin with antiseptic.
Dr. Stowell may draw lines on your elbow to specify structures like the ulnar nerve and olecranon bone. He may also draw lines for incision placements and portals for the arthroscope.
Dr. Stowell will fill your elbow joint with fluid. This will help him see more clearly all the structures of your elbow through the camera on the arthroscope. He will make several small incisions for the arthroscope and small surgical instruments. These specialized instruments are used for tasks like shaving, cutting, grasping, suture passing, and knot tying. Many times, special devices are used to anchor stitches into bone. Fluid flows throw the arthroscope to keep the viewing clear and control bleeding. This lessens the risk of injury to your blood vessels and nerves surrounding your elbow joint. Dr. Stowell will evaluate your elbow joint first before starting any specific treatments.
At the end of surgery, your arthroscopy incisions are usually stitched or covered with skin tapes with an absorbent dressing on the elbow. Depending on your procedure, Dr. Stowell may place an additional soft dressing that will allow movement or a plaster splint that will restrict mobility and provide better protection for your elbow.
After surgery, you will be transferred to the recovery room for about 1 to 2 hours before being discharged home. Nurses will monitor your responsiveness and provide medication, as needed. For some complex arthroscopic procedures, patients may need to stay at the hospital overnight. You will need someone to drive you home and stay with you for at least the first night.
It may take weeks to months for your elbow joint to completely recover. Arthroscopy is often faster than recovery from open surgery. You can expect some amount of pain and discomfort after surgery for several weeks. For more complex surgeries, it may take longer for your pain to subside. Dr. Stowell may prescribe pain medicine, anti-inflammatory medicine, and stool softener for you to take regularly for the first few days after surgery.
For 48 hours after surgery, it is important to ice and elevate your elbow often. In doing so, you will reduce your risk of swelling and it will also help reduce pain. When elevating your arm, make sure your elbow is resting above your heart and your hand is positioned higher than your elbow. Dr. Stowell will have specific instructions for ice and elevation depending on the type of surgery he performed.
To help stimulate circulation and minimize swelling, you are encouraged to move your fingers and wrists frequently. Dr. Stowell may recommend early range-of-motion exercises to prevent stiffness in your joint.
In most cases, the dressing must be left intact and dry for 2 to 3 days after surgery. Dr. Stowell may also advise that you keep your dressing and/or splint in place until your postoperative visit with him.
Most patients do not experience complications from elbow arthroscopy; however, as with any surgery, risks include:
- Excessive bleeding
- Blood clots
- Nerve or blood vessel damage
Before your surgery, Dr. Stowell will discuss with you the potential risks and benefits of elbow arthroscopy.
Dr. Stowell will develop a rehabilitation plan based on your surgical procedure. He may instruct some basic exercises to begin at home a few days after surgery. Physical therapy is often prescribed to help facilitate motion, regain strength, and return of elbow function. Your rehabilitation plays an important role in getting you back to normal activity.
Recovery times vary for different elbow conditions. For minor repairs, a splint may not be necessary and range of motion and function may return shortly after the procedure. For more complicated surgeries, recovery times are longer–several months to a year. Returning to work and basic daily activities will depend on your surgery and your strict adherence to the rehabilitation plan Dr. Stowell designed for you.