In addition to general anaesthesia, various regional anaesthesia procedures are also available for arthroscopy, in which the patient remains conscious but feels no pain. However, general anaesthesia is generally preferred to regional anaesthesia, as it allows maximum relaxation of the arm muscles, which makes the arthroscopy much easier for the surgeon. To perform the operation, the patient must also be positioned, with several options available.
The prone position is the most frequently used position and offers 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, a back positioning is 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. Lateral positioning is also possible, but is hardly ever used due to the even greater effort involved in positioning.
There are various possibilities for creating access routes to the joint during the operation itself. However, for a complete arthroscopic view of the elbow joint, at least one anterior and one posterior access are necessary. To ensure better visibility, the joint cavity is now filled with fluid.
If other instruments are to be used in addition to the arthroscope, further accesses must be created. In diagnostic arthroscopy, a complete tour of the joint is now performed and all structures are checked visually, functionally and by palpation with the instruments. Important or noticeable parts of the joint are photographed for documentation. Once the operation is finished, the arm should only be lightly strained for several days, but in most cases the wound will heal very quickly. Swelling after the operation is possible and should be cooled during the following days.
The arthroscopy procedure offers some advantages in the case of the elbow as well as in general. Because the joint does not have to be fully opened, postoperative pain and functional limitations are much less severe. The risk of infection is significantly lower compared to open surgery and is only about 0.1%. From a cosmetic point of view, there is also the advantage that scarring is very small.
Risks and complications
The complication rate for arthroscopies of the arm and in general is very low. In addition to rarely occurring infections and wound healing disorders, thrombosis can occur, as with all operations, which can be prevented to a large extent by the administration of blood-thinning medication. Nerve lesions occur relatively frequently, but in almost all cases they are temporary.
Furthermore, cartilage damage is possible and more frequent in the elbow than in the shoulder and hip, as the joint cavity is significantly smaller. All these complications can occur during both diagnostic and therapeutic use of arthroscopy.