Until recently, elbow surgery required large cuts, leaving wide scars and significant pain after surgery. But with recent advancements in optical and orthopaedic technologies, we can now perform many elbow procedures by making very small incisions for a tiny camera (arthroscope) and tools to view the inside of the elbow and fix it.
“Every year, new techniques and tools are introduced that make arthroscopic surgery more precise and consistent and therefore more successful.”
Why treatment is required
Elbow arthroscopy is often recommended for people with painful conditions that did not respond to nonsurgical treatments. Elbow arthroscopy can relieve pain by fixing problems with the cartilage and other soft tissues surrounding the joint. This treatment may also remove loose pieces of bone and cartilage or release scar tissue that is blocking motion.
How treatment is performed
Before surgery, most patients are given a numbing block in their shoulder and arm to anesthetize the nerves connected to the elbow. Afterward, the patient is either placed in a lying-on-the-side position, or on their stomach, depending on the type of elbow surgery required.
Four small cuts (each under half an inch) are made around the elbow. The arthroscope (camera) is then introduced into the front part of the elbow joint. Sterile salt water is used to inflate the joint and allow the safe placement of other instruments into the space.
Small instruments (surgical tools) are placed into the joint to check, probe, and diagnose any abnormalities or tears. Photographs and videos are taken of the different parts of the elbow to document its condition. Shavers are used to remove damaged tissue in tennis elbow surgery, and burrs are used when bone needs to be removed in arthritis surgery. Sometimes a piece of bone can be stabilized with a screw, or torn tissue can be repaired with bone anchors—all of which can be done with advanced elbow arthroscopy techniques.
At the end of the procedure, sutures (stitches) are used to close the small skin incisions and sterile dressings and adhesive bandages (e.g., Steri-Strips) are placed over top. When the patient wakes up, they will find their elbow covered in a dressing and their arm in a sling. For procedures that include ligament or tendon repairs or ligament reconstructions, patients may also have a hinged brace on their elbow. When the procedure is complete, the surgical team checks the blood circulation in the arm and looks for excess swelling or other problems before patients are discharged home. This procedure is usually done on an outpatient basis, meaning patients can usually go home the same day.
Risks and benefits
The advantages of elbow arthroscopy are:
- Smaller scars
- Less anesthesia
- Less pain after surgery
- Faster recovery
Every year, new techniques and tools are introduced that make arthroscopic surgery more precise and consistent and therefore more successful. Dr. Anthony Romeo has been instrumental in the introduction and design of many of the elbow arthroscopic procedures performed today, including the treatment of tennis elbow, baseball, and other overhead athlete elbow injuries, stiff elbows, and elbow arthritis.
The technical skills for elbow arthroscopy are much different from those for other joints as the risk of nerve injury is higher. Dr. Romeo takes extra care to ensure the procedure is done safely while protecting all of the nerves.
As your elbow recovers, it is important to stay alert for any signs of infection or other healing problems. Fortunately, these are rare.
Warning signs include:
- Numbness or tingling sensations in the hand or wrist
- Pain and redness near the incision
- Fever
- Chills
- Bleeding or other discharge
- Swelling that is beyond what is expected
“Recovery from an arthroscopic procedure is quicker than recovery from major surgery.”
Physical therapy protocols
After surgery, a sling is worn until the anesthesia wears off and the arm and hand are no longer numb. For procedures without tendon or ligament reconstruction, Dr. Romeo will encourage you to begin moving your shoulder, elbow, wrist, and hand within a few days of surgery. The first postoperative visit is in approximately ten days, after which physical therapy begins. A typical course of physical therapy includes up to three months of supervised exercises with a gradual return to full activities. Each person will require their own individualized physical therapy protocol depending on their surgery, injury, age, athletic goals, and more.
Pain control
Recovery from an arthroscopic procedure is quicker than recovery from major surgery. Some swelling is a normal part of the process. Ice packs applied to the site of the surgery several times a day can help ease swelling and discomfort. Dr. Romeo will give you specific instructions for post-op pain management.
Recovery time
People have a variety of elbow conditions, so recovery times are different for everyone. For minor repairs, people may not need a splint and they may regain their range of motion and function after a short period of rehabilitation. Some people are able to return to work or school within a few days of their procedure. For people with more severe injuries undergoing more complicated surgeries, it takes longer to recover.
Results
Despite the small incisions in arthroscopy, the procedure can repair extensive damage to the joint. Full recovery may take several months, depending on the complexity of the procedure performed. Although this process can be slow for some people, following proper recovery guidelines and protocols is the best way to ensure a successful outcome and full recovery.
FAQs
How soon will I be able to go home after my procedure?
Because people require much less anesthesia during arthroscopic surgeries, they can go home the same day, usually within two hours of being brought back to the recovery room.