Arthroscopy of Elbow

Elbow arthroscopy may relieve painful symptoms of many problems that damage the cartilage surfaces and other soft tissues surrounding the joint.

In Elbow Arthroscopy 4 – 5 small key holes are made around the elbow. A fibre-optic scope and small, pencil-sized instruments are inserted through small incisions instead of a large incision. The arthroscope is connected to a television monitor and the surgeon performs the repair under video control. The aim of the operation is to examine your elbow thoroughly followed by a full debridement, removal of inflamed synovium, removal of any loose bodies as well as removal of loose cartilage fragments. Any extra bone is also shaved off to try to improve the elbow movements. Sometimes the key hole may have to be converted to open to remove large loose pieces or provide better access.

The wound is then closed with some dissolvable sutures under the skin and butterfly stitches. The arm is then covered with waterproof dressing and a bulky bandage and placed in a sling.

Common arthroscopic procedures include:

Removal of loose bodies (loose cartilage and bone fragments)
Release of scar tissue to improve range of motion
Treatment of osteoarthritis (wear and tear arthritis)
Treatment of tennis elbow (lateral epicondylitis)
To diagnose non specific elbow pain

Questions that are often asked

Is the surgery necessary?

This depends on the severity of symptoms. If after a trial of non-operative treatment your symptoms are persisting and cause pain and difficulty in your activities surgery may be considered.

Before Admission:

No food for 6 hours, or drink for 2 hours, prior to surgery.
Please avoid smoking for 12 hours prior to surgery.
Please continue to take all your medication as advised by the preassessment team.

What happens on the day of surgery?

You will need to report to the main reception on arrival. You will be shown to your room where you will be checked in by the nurse and also see Prof. Singh and the anaesthetist. This will give you chance to ask any questions before surgery. You will also be given an approximate time of your procedure. Please read the instructions on ‘Preparing for Surgery’.

What are the possible complications?

Complications relating to anaesthesia,
Infection (< 1 in 1000)
Mild stiffness in early stages is quite common but occasionally patients may develop contracture again (5%) which will prolong your recovery by a few months.
This is common for the first few weeks after surgery but steadily settles. Some patients may have some discomfort at 2-3 months post operatively and may require steroid injection.
Failure to improve. 90% of patients will make a good or excellent recovery. 10% will have some ongoing discomfort but will be satisfied with their outcome. About 5% of patients will have ongoing problems, such as pain and stiffness, and some of these require further surgery.

What kind of anaesthesia is used?

A combination of general anesthesia and a nerve block is used for most surgeries. Before the surgery, the anaesthetist will inject numbing medicine around the nerves of the shoulder. This numbs the arm and helps to control your pain after surgery.

How long will I be in the hospital?

The surgery is done as a day case and should home within a few hours.

After hospital care:

Sling: After your surgery, you will be fitted with a high arm sling, which is to be used for 48 – 72 hours weeks.

Removal of stitches & Wound Care: Usually there are no stitches to be removed. You will have a thick dressing over your wound on your elbow. The ward staff will advise you when and how it should be removed. This is usually changed at 24 – 48 hours after surgery. The butterfly stitches can be inspected by the practice nurse at your GP surgery. You can get into shower after 3 days with the dressings on and leave the wound free to air after 10 days. If any stitches need to be removed, the team will inform you.

Medication: The nerve block usually lasts between 18 – 24 hours. Patients are encouraged to start taking painkillers before the pain starts i.e. on return home and for at least 48 hours.

Follow-up orthopaedic clinic: You will need to be reviewed in clinic after your operation. This is usually 2 –4weeks after surgery.

Physiotherapy A physiotherapist will assess you at the time of your operation and will give you exercises to do before you go home. You will be referred to physiotherapy either in the community or an outpatient department.

Return to Work: Return to Work: Sedentary: 1 –2 weeks, Light Manual: 2 – 4 weeks (e.g. clerical, secretarial), Medium Manual: 4 – 6 weeks (cleaner, nurse etc.), Heavy Manual: 6 – 8 weeks (ground worker, labourer, etc.). Please discuss with your consultant / therapist if you have any queries.

Driving: When you feel comfortable within a few days as long as you have control over the vehicle you are driving.