Elbow arthroscopy

Summary

This operation is performed for simple problems occurring in the elbow such as early arthritis, loose bodies or cartilage problems.  The elbow, like most joints, can be operated on through keyhole surgery.  Loose bodies or early arthritis (wear and tear) can cause the elbow to catch and cause pain.  Keyhole surgery can manage these problems effectively with minimal exposure of the joint. 

Factors to Consider

Pain in the elbow can be caused by a variety of reasons.  Your surgeon will examine you and determine whether the problem is from inside your elbow.  If this is the case then it is likely that elbow arthroscopy can be performed to resolve it.  

This includes pain and catching from loose bodies of cartilage or thickened/frayed joint capsule.  It also includes early arthritis that causes pain at the extremes of movement due to osteophyte (increased bone) formation.  Keyhole surgery can remove the causative factors but can not reverse any arthritic changes.

It is likely that you will have undergone investigations beforehand to diagnose your condition.  Occasionally an elbow arthroscopy can be performed to help diagnose what is wrong with your elbow.  

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is usually performed through keyhole surgery using 2 small (less than 1cm) cuts to your elbow.  The surgeon is able to look at your elbow joint and manage the cause of your symptoms.  Occasionally the surgeon may make a larger cut (about 3cm) to your elbow, more commonly at the back to gain access to harder parts of the elbow joint to reach through keyhole surgery.

Anaesthetic

The operation is usually performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The risk of infection is very small and is thought to be about 0.5%.  Most infections will settle simply with antibiotics.

Damage to nerves and blood vessels around the elbow can occur but this is rare.  The elbow can develop stiffness after surgery.  This will usually resolve with physiotherapy but occasionally may require further procedures.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the elbow may be sore after it wears off.  You will be given a combination of pain killers to go home with.  It is important that you take regular pain relief so that you can start moving your arm early.  

Dressings

You will wake up with your arm in a bulky bandage.  This can be removed 2 days following the surgery and is used to help with swelling.    There will be dressings applied to the wound under these bandages.  These can occasionally come off and will need to be replaced during the first 2 weeks after surgery to protect the wound.  

The dressings are splash proof but not waterproof and so you should avoid getting them wet.

The wounds are closed using non-dissolvable stitches.  The stitches will need to be removed at 10-14 days following surgery.  The nurses will arrange this to be done at your local GP practice before you are discharged.

You may be given a sling but this is only for comfort.  You can get rid of the sling as soon as you feel comfortable.

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you within 3 weeks of the operation.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road.  This will vary between patients but normally takes about a week.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable.  Your symptoms should be improved/improving by 3 months with the majority fully recovered by 6 months.  It can, however, take up to a year for some patients to fully improve.