How is the procedure performed?
The procedure is performed under a combination of general and regional anaesthesia. The elbow is examined under anaesthesia and the range of movements noted. An arthroscope is inserted into the joint after distending it with saline. The inside of the joint is examined. Any scar tissue within the joint is cleared with a radiofrequency device to create space for surgery. Loose bodies are removed with a special grasping tool. Any bone spurs are removed with a chisel and mallet or with an arthroscopic shaver (motorised “burr”). Finally the capsule is release circumferentially around the joint. The joint is stretched at the end of the procedure.
Benefits
The main benefit of the procedure is to improve the range of movements and function of the elbow. More than 90% of patients achieve a substantial improvement in the range of movement following surgery.
Risks
Pain - The elbow may be painful for some days after surgery. This is usually managed by taking appropriate pain relieving medication and activity modification.
Swelling – During the procedure, the joint is distended with saline and this may lead to the elbow remaining swollen for a day or two after surgery. You should keep your elbow elevated as far as possible to help relieve the swelling.
Bleeding – A small amount of bleeding from the arthroscopy portal sites is not unusual and will usually settle after a day or two.
Residual Stiffness – The joint may feel stiff in the initial phase after surgery. This is partly due to swelling. Prevention is the key and it is essential to follow the instructions provided, keep the elbow elevated and perform daily stretching and exercises at home to maintain the range of movements. It is not uncommon for some residual stiffness to persist.
Infection – Infection is a possibility but rare after arthroscopic surgery (1%).
Persistent drainage – Persistent drainage is rare but may suggest infection and you should seek attention immediately.
Nerve injury – Injury to the nerves around the elbow is possible but rare. This may result in temporary numbness or weakness around the hand, wrist or forearm (3-5%). Permanent nerve injuries are extremely rare (<1%).
Aftercare
Following the procedure the arthroscopy portal sites (skin incisions) will be closed with tape or sutures and covered with shower-proof dressings. These dressings should be left undisturbed as far as possible for 5-7 days. If the dressings are removed for any reason they should be replaced with similar dressings or waterproof plasters. A compression bandage is applied after surgery and will usually be removed the next day. To help maintain the range of movements achieved at surgery, your elbow will be placed on a CPM (Continuous Passive Motion) machine whilst you are in hospital and you may be advised to wear a brace after surgery. A sling will be provided to support the arm, but may be removed as tolerated to move the arm and is usually discarded after 2-3 days. A physiotherapist will provide instructions about mobilising the elbow and using a brace prior to discharge from hospital. Outpatient physiotherapy may occasionally be recommended but is not always necessary. You may resume driving after 5-7 days. Sutures are removed at two weeks.
Follow-up
An appointment will be arranged for you to be seen in the outpatient clinic within two to four weeks after the procedure. Follow-up is required for at least 3-6 months after surgery or until a satisfactory recovery is achieved.