Elbow arthroscopy in Tunisia
Arthroscopy is a procedure orthopedic surgeons use to check, diagnose, and repair joint problems. The word arthroscopy comes from two Greek words, ἄρϑρων “artron” (joint) and ςκω π ειν “skopein” (to look). The term arthroscopy literally means "to look inside the joint". During elbow arthroscopy, your surgeon inserts a small camera, called an arthroscope, into the elbow joint. The camera displays and records the images on a television screen, and the surgeon uses these images to guide miniature surgical instruments.
Due to the fact that arthroscopic instruments are very thin, the surgeon can operate through very small incisions (cuts), rather than through a large incision required for traditional open surgery. This translates to less pain for patients, less risk of joint stiffness, and often reduces the time needed to recover and resume activities. The first elbow arthroscopy was performed in 1980. Since then, many advances have been made in both technique and instrumentation. Today, we are able to diagnose, treat pathologies and quickly recover a patient in a way and in a time that would never have been imagined before the advent of this surgical technique. Every year improvements are made in the surgical technique of elbow arthroscopy and new tools and techniques are developed.
Indications for elbow arthroscopy
The role of elbow arthroscopy in the treatment of elbow joint disorders has increased significantly in recent years. There are a variety of pathological conditions for which elbow arthroscopy can be helpful in the diagnosis and treatment, including arthritis, loose bodies, tennis elbow, stiffness, and fractures.
Fractures and other injuries to the elbow can lead to significant and disabling degrees of joint stiffness. Post-traumatic stiffness can be successfully treated with the arthroscopic technique. Although not curable by arthroscopy, patients with osteoarthritis of the elbow may experience significant improvement in symptoms and function after arthroscopy. After the physical exam, X-rays, or other studies such as CT scans or MRIs, your surgeon may recommend an arthroscopic procedure to treat your elbow disorder.
Your doctor may recommend elbow arthroscopy if you have a painful condition that does not respond to non-surgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation. Inflammation is one of the body's normal reactions after trauma or illness. In a traumatized or diseased elbow, the inflammation causes swelling, pain, and stiffness.
Trauma, overuse, and age- or sport-related wear and tear are responsible for most elbow problems. Elbow arthroscopy can relieve painful symptoms of many problems that damage the cartilage surfaces and soft tissues surrounding the joint. Elbow arthroscopy can also be used to remove pieces of bone and cartilage (floaters) or to free up scar tissue that blocks their movement.
Common arthroscopic procedures include:
Tennis elbow treatment.
Removal of floaters (cartilage and bone fragments).
Scar tissue release to improve mobility.
Treatment of osteoarthritis.
Treatment of rheumatoid arthritis (inflammatory arthritis).
Treatment of osteochondritis dissecans (damage related to the capitulum humeri commonly seen in gymnasts).
However, there are several surgical elbow treatments that are currently more effective if treated with the traditional open procedure (clicking the links below will take you to 3D tutorials with interactive videos to learn more on the following diseases that are treated with traditional surgery):
Golfer's elbow (medial epicondylitis).
Collateral ligament repair.
Ostesynthesis of numerous fractures.
Replacement of the elbow joint with a prosthesis.
Ulnar nerve decompression.
Some advanced surgeries combine arthroscopic and traditional procedures in the same surgery. For example, in a severe case of osteochondritis dissecans, a piece of loose bone can be removed arthroscopically and the damaged area of the humerus can be treated with a bone graft using an open surgical technique.
Assessments and tests
The orthopedic surgeon may ask you to be assessed by your GP to ensure that you do not have any health issues that need to be addressed prior to surgery. Blood tests, an electrocardiogram, or a chest X-ray may be needed to perform your surgery safely.
If you suffer from certain health risks, further evaluation may be required prior to surgery. Be sure to tell your orthopedic surgeon about any medications or supplements you take. You may need to stop taking some of these medications before surgery.
How is an elbow arthroscopy performed?
A fiber optic camera is inserted through a small incision, or portal, in the elbow. The camera lens zooms in and projects small structures in the elbow onto a television screen, allowing the surgeon to accurately diagnose the condition.
Some other small portals are used to allow the surgeon to place the camera in different positions to view different structures inside the joint and to place the various small tools that will be used to treat various problems. Elbow arthroscopy is sometimes combined with open procedures.
After elbow arthroscopy
After surgery, the elbow can be placed in a cast splint that will immobilize it while allowing full hand mobility. Immobilization time varies depending on what was done at the time of surgery. Limb elevation is important to prevent excessive swelling and decrease pain after surgery. In some cases rehabilitation may begin immediately while in others it may be delayed for a few days to allow the repaired tissues to rest and heal. Hospitalization is generally very short (24 to 48 hours).
Although recovery from arthroscopy is often faster than traditional surgery, it can still take several weeks for your elbow to fully recover. You can expect pain and discomfort for at least a week after surgery. The doctor will prescribe analgesics to better manage postoperative comfort. It is important to apply ice and elevate the elbow regularly for 48 hours after surgery. This will reduce swelling and help relieve pain. When raising your arm, if you find yourself lying in bed, make sure your elbow rests higher than your heart and your hand is positioned higher than your elbow. You will be encouraged to move your fingers and wrist frequently to stimulate circulation and reduce swelling. Your doctor may immediately prescribe passive elbow motion exercises to reduce the risk of stiffness, or they may bind your elbow in a cast splint for about 5 to 10 days.
Rehabilitation plays an important role in getting you back to your daily activities. A rehabilitation program will help you regain movement and strength in your elbow and forearm. The surgeon will provide you with a rehabilitation plan based on the surgical procedures performed. In some cases, you will start as early as a few days after surgery. Especially in the beginning, the help of professional physiotherapists is very helpful. The type and length of treatment will depend on the type of problem you had and the type of surgery that was performed. Returning to driving, basic activities of daily living, and returning to work depend on the type of surgery performed and will be discussed with your orthopedic surgeon prior to surgery.
Most patients will have no complications from elbow arthroscopy. However, as with any surgery, there are certain risks. These are usually mild and treatable and may not affect your end result. Potential complications of elbow arthroscopy include infection, excessive bleeding, blood clots, and damage to blood vessels or nerves.
Your doctor will discuss with you the potential risks and benefits of elbow arthroscopy prior to surgery. These risks depend on the type of surgery and the surgeon's experience with this procedure.
Like any surgery, elbow arthroscopy also carries risks. These include:
Potential damage to nerves and arteries.
Stiffness: The elbow may become stiff over time due to adhesions formed by scar tissue caused by the surgery itself. This may sometimes require mobilization in the narcosis.
Full recovery time differs from patient to patient.
If you have had a minor repair, you may not need a splint and your range of motion and elbow function may be recovered after a short period of rehabilitation. You may be able to return to work if your job does not involve heavy lifting or going to school in the days following surgery. It takes longer to recover from more complicated procedures. Even though the skin incisions are small in arthroscopy, the work that is done inside the joint to fix your problem can still cause bruising and adhesions to form which will be more abundant as you will have to work because of your pathology. In these cases, full recovery can take several months. Although it can be a slow process, it is essential to follow your surgeon's guidelines and rehabilitation plan to achieve a satisfactory outcome.
Ultimately elbow arthroscopy is not indicated for all elbow pathologies and the result, as well as the speed of recovery, although better than traditional open surgery, will depend on the pathology, the patient's experience surgeon, your commitment and your expectations.