Certain elbow conditions may require surgery – especially if conservative treatment options have not been successful. For example, tendon tears may require surgery to remove or repair the damaged tissue and to restore strength in the elbow. Some elbow surgeries can be done with an arthroscope. During this surgery, your surgeon places their surgical instruments through two small incisions to make repairs. An arthroscope causes less harm to healthy tissues and greatly reduces recovery time compared to traditional surgery. Some common elbow problems that can be treated with arthroscopy include bone spurs, cartilage damage, tendon tears, and arthritis. Often times, multiple elbow conditions can be addressed at one time with arthroscopic elbow surgery.
Elbow arthroscopy is an outpatient procedure, which means you do not have to stay overnight in the hospital. For this procedure, you will arrive at the facility about an hour before your actual surgery time. Our staff will check you in and conduct a brief health check by listening to your heart and lungs and checking your blood pressure, pulse, and temperature. We will then start an IV to give you fluids and medications. The anesthesia staff will discuss your options for medications during surgery. Often times, a monitored anesthetic will allow you to relax and fall asleep without the effects of a general anesthetic. At the end of your surgery, a local anesthetic is injected into the elbow to help manage initial discomfort. Your surgery time can vary depending on how much repair needs to be done, but can last anywhere from 30 to 90 minutes.
Once you are fast asleep in the operating room, your elbow gets filled with saline. Saline helps expand your joint, making it easier for your surgeon to move surgical instruments and better see tissues. To be able to see inside of your joint, your surgeon puts an arthroscope into your elbow, which is a tiny camera hooked up to a large computer screen. This magnifies the structures in your elbow and allows your surgeon to view it with their own eyes. Once your surgeon can see in the joint, they make another incision to insert their surgical instruments and are able to repair the damaged tissue. While in your elbow, your surgeon will usually fix any repairable damage they find, even if it was not expected before surgery. Even MRIs can miss damage in your elbow, but during an arthroscopy, your surgeon can see exactly what is problematic. A Physician Assistant (PA) often helps your surgeon throughout surgery and understands everything that was done during your surgery.
After surgery, your surgeon will explain what they found in the operating room to your family and will discuss any limitations you may have in using your arm. You will be placed in a sling for the first day and can typically wean from it as you feel ready. Usually, your surgeon will ask you to just rest and recover for a few days after surgery. After those few days, you may take off the bulky dressing from surgery and are allowed to shower. As you can imagine, it can be difficult to care for yourself after an elbow arthroscopy, and you may find you need extra help. Your surgeon will be sure to tell your family if you have any specific restrictions after surgery.
After an arthroscopy, patients can expect to be seen by either their surgeon or a Physician Assistant in 7-14 days. At that time, they will discuss with you what they found during your surgery, what was done, and your recovery process. You will be asked to make a fist and use the muscles of the forearm right after surgery to increase blood flow and help prevent a blood clot from forming in your arm. This is important since your activity level will decrease right after surgery. On average, it takes most patients four to six weeks before they are back to their daily activities; however, it can take up to six months to a year before they no longer notice any elbow pain.
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Hard Cartilage Damage and Arthroscopic Chondroplasty
Your elbow joint is the area where your upper arm bone (humerus) and your forearm bones (ulna and radius) meet. The elbow is responsible for not only bending and straightening your arm but also turning your hand palm up and palm down. These bony surfaces are covered by hard cartilage and should ideally be smooth. If there is a defect or flap in the hard cartilage it can cause your elbow to have a painful catch or click, which can limit the motion of your elbow and make it hard to straighten out your arm. If the defect is relatively small, it can sometimes be polished and smoothed out with gentle motion exercises, like using an arm bike with no resistance. If the hard cartilage damage is severe, surgical intervention may be required to remove the unstable flap of tissue.
An elbow chondroplasty is an arthroscopic procedure to smooth out damaged hard cartilage. Once the problematic area is known, a surgical instrument is used to remove the fraying or flapped hard cartilage and smooth down the remaining tissue. After this procedure, you are often placed in a sling for comfort and can begin to wean from this as you tolerate. Your surgeon will tell your family exactly what your restrictions are after surgery.