Arthroscopy of the elbow joint

General

Arthroscopy, also known as joint endoscopy, is a minimally invasive procedure in orthopedics and trauma surgery that can be used both diagnostically and therapeutically for injuries and degenerative changes.

The arthroscopy is performed through small incisions (Arthrotomies) and with the help of an arthroscope (a special form of endoscope) and is a very popular procedure for all larger joints, but now also for smaller joints such as the wrist. Arthroscopy has been gaining in importance for a number of years, especially for the elbow joint, but is still used far less often on this joint than on the knee or shoulder, for example.

indication

One area of ​​application for performing an arthroscopy is surgical removal from Osteophytes. This is New bone formationwhich are mainly in the context of Wear-related (degenerative) Bone changes form. One example of this is arthrosis, in which the bone is increasingly stressed because the pressure and friction that act on the joint surface can no longer be distributed by the cartilage to the entire joint surface. Their removal is relatively complex as they can vary greatly in size and shape. To be removed from them chisel and Shaver (rotatable knife with a device for suctioning off removed material) is used.

Another indication is osteoarthritis itself. Bumps, fraying and cracks in the context of Wear and tear on the cartilage can become pinched when moving the joint and can be very painful. These can be removed very easily with the help of a shaver. Overall, however, lesions of the articular cartilage of the elbow are much rarer than those of the shoulder or knee joint.

It can also be found in joints Adhesions or wrinkles, for example the joint capsule. These structures will free joint bodies and can also be removed using arthroscopy. Studies have shown that removing them very often leads to a significant reduction in pain. In order not to miss any free joint bodies, an accurate diagnosis of the joint is necessary before and during the operation.

Contraindications (Contraindications) of arthroscopy in general only exist in Infections in the area of ​​the operation area and one poor general condition of the patient.

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preparation

As with any other operation, the patient before the procedure about the procedure itself, as well as possible Risks and Complications cleared up become. This takes place both through a conversation with the surgeon and through information sheets. This also includes a neurological examination of the elbow area to rule out any existing nerve damage. In addition, the patient and doctor must do this together Weigh the risk-benefit ratio of the procedure and consider possible other therapeutic and diagnostic options. This is done before every arthroscopic procedure by creating a X-ray image in two levels (side and rear). If necessary, an MRI (magnetic resonance tomography) or CT (computed tomography) can also be made, which can even replace the diagnostic use of arthroscopy. Finally there is a separate one Education about the anesthesia and possibly a physical examination to clarify the possible risks of general anesthesia by the Anesthetists. Further examinations, including the ligamentous apparatus of the elbow, can be carried out completely painlessly shortly before the operation after anesthesia has been carried out.

procedure

Besides the general anesthetic there are also different types of arthroscopy Regional anesthesia procedure available where the patient remains conscious but does not feel pain. As a rule, however, general anesthesia is preferred to regional anesthesia, as this allows maximum relaxation of the arm muscles, which makes performing the arthroscopy much easier for the surgeon.

In order to perform the operation, a storage of the patient, with several options. The Prone position is the most frequently used form of positioning and has the advantage that the rear parts of the joint are easily accessible. The disadvantage is that this position quickly becomes uncomfortable for the awake patient; unconscious movements are the result. Furthermore is a Supine position possible. However, this has some disadvantages. Among other things, the positioning of the arm is much more complex and the rear area of ​​the elbow joint is more difficult to reach. A lateral storage is also possible, but is rarely used because of the greater expense involved in storage.

There are various options for creating access routes to the joint during the operation itself. However, for a full arthroscopic examination of the elbow joint at least one front and one rear entrance necessary. To a better sight to ensure the Joint cavity now filled with liquid. If other instruments are to be used in addition to the arthroscope, additional accesses must be created. In the diagnostic arthroscopy a complete tour of the joint is now made and all structures checked visually, functionally and by touching (palpation) with the instruments. Important or noticeable parts of the joint are photographed for documentation.

Once the operation is over, the arm should be used for several days only lightly loaded wound healing is very rapid in most cases. Swelling after the operation are possible and should be done during the next few days chilled become.

advantages

The arthroscopy procedure offers some in the case of the elbow as well as in general advantages. Because the joint does not have to be opened completely, fall post-operative pain and Functional restrictions very much lower out. The risk of Infections is significantly less and amounts to compared to an open operation only about 0.1%. From a cosmetic point of view, there is also the advantage that the Very little scarring fails.

Risks and Complications

The Complication rate in arthroscopy on the arm as well as in general very low. Next rare infections and Wound healing disordersAs with all operations, it can too Thrombosis come, which can be largely prevented by administering blood-thinning medication. Nerve lesions occur relatively frequently, but are in almost all cases limited. Furthermore are Cartilage damage possible and at the elbow more oftenthan the shoulder and hip, as the Joint cavity significantly smaller is. All of these complications can arise in both diagnostic and therapeutic applications of arthroscopy.