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Evaluations and Tests

Your orthopaedic surgeon may ask you to see your primary doctor to make sure that you do not have any medical problems that need to be addressed before your surgery. Blood tests, an electrocardiogram, or chest X-ray may be needed to safely perform your surgery.

If you have certain health risks, a more extensive evaluation may be necessary before your surgery. Be sure to inform your orthopaedic surgeon of any medications or supplements that you take. You may need to stop taking some of these prior to surgery.

If you are generally healthy, your arthroscopy will most likely be performed as an outpatient procedure, meaning you will not need to stay overnight at the hospital. However, there are some procedures that have better results when patients stay in the hospital afterward for close monitoring, physical or occupational therapy, and/or pain control. Your surgeon will discuss a hospital stay with you if necessary.

Anesthesia

Elbow arthroscopy may be performed with:

• General anesthesia, meaning you are put to sleep with a breathing tube
• A regional nerve block that numbs your arm
• A combination of both types of anesthesia

Sometimes, the regional nerve block is placed after your procedure, while you are in the recovery room, so your surgeon can make sure your nerves are functioning well after surgery and that there has not been any injury.

Positioning

Once in the operating room, you will most likely be given general anesthesia (see Anesthesia section above), as well as intravenous antibiotics. Antibiotics are typically given before surgery to lessen the risk of infection after surgery.

You will then be positioned so that your surgeon can easily adjust the arthroscope to have a clear view of the inside of your elbow. The two most common positions for elbow arthroscopy are:

• Lateral decubitus (lying on your side)
• Prone (lying on your stomach)

Some surgeons may also choose to perform this procedure supine (with you lying on your back). The decision is often based on surgeon preference.

Care is taken to ensure that your spine and other pressure points in your arms and legs are protected and padded after positioning.

A typical position of the elbow for surgery. The arm is kept in position with an arm holder device.

Reproduced from Gramstad G, Yamaguchi K: Elbow arthroscopy. American Academy of Orthopaedic Surgeons website: Orthopaedic Knowledge Online Journal, 2007. http://orthoportal.aaos.org/oko/article.aspx?article=OKO_SHO011&section=3&#article. Accessed 7/25/2012.

Next, a tourniquet is applied to your upper arm which is then placed in an arm holder to keep it in position during the procedure. A compressive dressing may be applied to your lower arm and hand to limit swelling. The surgical team will clean your skin with antiseptic and cover your shoulder and upper body with sterile surgical drapes.

Surgeons typically draw lines on the elbow to indicate specific structures (such as the ulnar nerve and olecranon bone), as well as incision placements and portals for the arthroscope. This is done to minimize the risk of injury to the vital structures, like nerves, around the elbow.

The small lines drawn on the skin are common incisions made during arthroscopic surgery.

Procedure

• Your surgeon will first fill the elbow joint with fluid. The fluid helps your surgeon more clearly see the structures of your elbow through the camera on the arthroscope. This lessens the risk of injury to the blood vessels and nerves surrounding your elbow joint.
• Your surgeon will make several small incisions to introduce the arthroscope and small instruments into the joint. Fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen showing your surgeon the inside of your elbow and any problems.
• Your surgeon will evaluate the joint before beginning any specific treatments. If necessary, the entire joint will be evaluated, which may require a total of 5 or 7 more very small arthroscopy incisions (cuts). 
• Specialized instruments, inserted through the small cuts, are used for tasks like shaving, cutting, grasping, suture passing, and knot tying. In many cases, special devices are used to anchor stitches into bone.

During arthroscopy, your surgeon inserts the arthroscope and small instruments into your elbow joint.

• The arthroscopy incisions are usually stitched or covered with skin tapes at the end of the surgery. An absorbent dressing is applied to the elbow. Depending on the procedure, your surgeon will place either an additional soft dressing that will allow movement or a plaster splint that will restrict movement and better protect the elbow.

Loose pieces of bone and bone spurs removed from an arthritic elbow during arthroscopy.

Postoperative

After surgery, you may stay in the recovery room for several hours before being discharged home (if you are having outpatient, or same-day, surgery). For some complex arthroscopic procedures, patients may be admitted to the hospital overnight.

Nurses will monitor your responsiveness and provide pain medication, if needed.

You will be provided discharge instructions that cover medications, need for ice and elevation, as well dressing care.

You will need someone to drive you home and stay with you for at least the first night.

At Home

Although recovery from arthroscopy is often faster than recovery from open surgery, it may still take weeks to months for your elbow joint to completely recover.

Medications

You can expect some pain and discomfort for several weeks after surgery. If you have had a more extensive surgery, however, it may take longer before your pain subsides.

Your doctor will likely prescribe pain medicine to be taken regularly for the first few days after surgery. In addition, other medicines such as stool softeners or anti-inflammatory medicines may be prescribed.

Icing and Elevation

It is important to ice and elevate your elbow regularly for 48 hours after surgery. This will reduce the risk of severe swelling and help to relieve pain. Icing can sometimes be difficult if you have a bulky dressing.

When elevating your arm, whether you lie flat or recline, make sure your elbow is resting higher than your heart and your hand is positioned higher than your elbow. Depending on the type of surgery performed, your doctor may have specific instructions for longer periods of ice and elevation.

Movement and Exercises

You will most likely be encouraged to move your fingers and wrist frequently to help stimulate circulation and minimize swelling.

Your doctor may recommend early range-of-motion exercises to prevent joint stiffness. When you can start these gentle exercises, as well as return to daily activities, will depend on the type of surgery performed.

Dressing Care

Dressing care will also depend on the type of surgery performed and the preferences of your doctor.

In most cases, the operative dressing and/or splint is removed 2 to 3 days after surgery. While you are wearing the dressing, it must be left intact and kept dry. In some instances, you may be instructed to keep the dressing in place until your first postoperative clinic visit with your doctor.