Elbow Arthroscopy
Keyhole surgery is also known as elbow arthroscopy. A series of small cuts, typically 1cm or less, is made around the elbow. The joint is inflated with fluid to create more space to move the instruments around. The surgeon inserts a camera into your elbow joint and look for any damage, such as signs of arthritis, or loose fragments that may cause the elbow to lock up. Through the same holes, special instruments are used, including shavers to remove excess bone.
Surgery is usually performed under general anaesthetic with a nerve block. The nerve block is performed by the anaesthetist. It involves an injection of local anaesthetic around the nerves in your neck and may be performed before or after you have been put to sleep. Nerve blocks provide excellent pain relief for the first 12-24 hours after surgery.
As with any surgery, it is important to discuss the benefits and risks with your surgeon.
Risks of Elbow Arthroscopy
Surgery in general is safe and few people have serious side-effects. However, when weighing up whether you would like to proceed with surgery, it is important that you know the risks, as well as the benefits. Whilst each operation has its own specific risks, all keyhole elbow operations share some common risks. These are:
- Infection: Small cuts are made in the skin to perform the operation. As with any cut, these can get infected. This risk is kept to a minimum by performing surgery in a clean environment and sometimes giving a dose of antibiotics before starting. The risk of an infection in the skin is around 1 in 400 and it is usually treated successfully with antibiotics. Rarely, you can develop a deeper infection in the elbow joint. This is very painful and can make you unwell. It may require further surgery to wash the infection out. The risk of this is estimated at less than 1 in 1000. There is a higher risk of infection if you have problems with your immune system, are on medications that reduce your immunity such as steroids, have had previous surgery on the elbow, or are very overweight.
- Bleeding: It is normal to have some leakage of blood-stained fluid from the wounds for 24-48 hours after this type of surgery because large amounts of fluid are used to 'inflate' your joint. It is very rare to have any significant bleeding due to damage to major blood vessels.
- Nerve Damage: Nerves are the electrical cables that supply feeling to the skin and also work the muscles that you use to move your hand and wrist. All of the important nerves that work your hand and wrist are close by in this procedure. Despite taking great care not to do any damage, around 1 in 40 patients do develop nerve problems after surgery. This can lead to temporary or permanent loss of feeling (numbness) or movement (paralysis) anywhere around your hand or wrist.
- Stiffness: Some people develop stiffness in their elbow after surgery, leading to a reduction in movement. This is identified by your surgeon or physiotherapist and usually responds to an intensive course of physiotherapy.
- Ongoing pain: Around 80% of people notice an improvement in their pain after recovering from their surgery. Complete pain relief is possible, but some people still have some ongoing pain. Occasionally, people do not notice any benefit from the surgery and this is something that can be looked into further by your surgeon. Rarely, people report that after surgery, the pain is worse than before.
- Risks of Anaesthetic: Before your operation, you will have your preop health checkup. Serious problems related to the anaesthetic are very rare (less than 1 in 10,000 for healthy people), but can be serious and sometimes life-threatening. These problems may include heart attack or a stroke, which can affect the movement of any part of your body, speech problems or even blindness. With any surgery, there is also a risk of a blood clot in your leg (DVT / deep vein thrombosis) or lung (PE / pulmonary embolism) and some people are given blood-thinning medications if their risk is higher. Your anaesthetist and surgeon can discuss your own personal risks and the measures they take to keep you as safe as possible throughout surgery.
Recovery
A sling is provided for comfort for the first 1–2 days, but early movement is encouraged to prevent stiffness. Most patients return to driving within 1–2 weeks and desk work within 2–4 weeks; heavy lifting and overhead activities should be avoided for 4–6 weeks. Light exercise typically resumes at 4–6 weeks, with full return to sport over the following months guided by physiotherapy progress.