Elbow Arthroscopy
Elbow arthroscopy is a closed surgical technique used in conditions such as loose bodies within the joint, restricted movement (stiffness) and resistant tennis elbow. Because nerve and vessel structures run close to the joint, the choice of portals is of particular importance.
The Structure of the Elbow Joint
The elbow is a compound joint where the upper arm bone meets the two bones of the forearm (radius and ulna), allowing both bending–straightening and rotation of the forearm. Important nerve and vessel structures, notably the ulnar nerve, run around the joint. For this reason, choosing portals in accordance with the anatomy is critical in elbow arthroscopy.
In Which Conditions Is It Considered?
- Removal of loose bodies within the joint — these can cause catching and locking
- Elbow stiffness — release of adhesions and capsular contracture
- Resistant tennis elbow — in cases not responding to conservative treatment
- Osteochondritis dissecans and cartilage lesions (particularly in young athletes)
- Synovitis and joint lining problems related to rheumatological disease
- Impingement syndromes (posterior impingement) — may be seen in throwing sports
- Debridement and procedures aimed at improving range of movement in osteoarthritis
When Is Surgery Considered in Tennis Elbow?
The great majority of tennis elbow (lateral epicondylitis) cases resolve without surgery. Activity modification, an exercise programme (particularly eccentric strengthening), bracing, pain management and, in selected cases, injection treatments are the first-line treatments. Surgical options may be considered in cases that persist for a long time, markedly restrict daily life and do not respond to these treatments.
Diagnosis and Assessment
- History: the site of pain, repetitive occupational and sporting movements, any history of locking or catching.
- Physical examination: range of movement, points of tenderness, nerve examination (particularly the ulnar nerve), stability tests.
- X-ray: assessment of loose bodies, bone prominence and joint space.
- MRI / CT: cartilage, tendon and soft tissue assessment; bone detail where required.
How Is the Procedure Performed?
In elbow arthroscopy the joint is first distended with fluid; this helps move the nerve structures away from the joint surface. The camera and instruments are introduced through a few small portals. Depending on the problem identified, removal of loose bodies, capsular release, correction of bone prominence or treatment of diseased tendon tissue is carried out. The procedure requires careful attention to anatomical boundaries and nerve pathways.
Preparing for the Procedure
- Prepare an up-to-date list of every medication you take, including herbal supplements.
- If you take blood thinners, be sure to say so; your physician decides when they are stopped.
- Bring any previous MRI, X-ray and operation reports with you.
- Follow the fasting instructions; this is critical for the safety of anaesthesia.
- Arrange your transport home and someone to accompany you in advance.
For detailed preparation headings, see the Preparing for Orthopaedic Surgery page.
The Postoperative Period
One of the most important goals in the elbow is preserving range of movement in the early period; the elbow is more prone to stiffness than other joints when immobilised for long. For this reason an early, controlled movement programme is started in most cases. Strengthening is added gradually once range of movement has been regained.
Risks and What You Should Know
Although arthroscopy is a closed technique, it is still a surgical procedure and every surgical procedure carries risks. The headings below are for general information; your individual risk assessment is made by your physician after examination and investigations.
- Infection — a risk present in every operation, despite the small portals.
- Bleeding or swelling within the joint
- Involvement of nerve and vessel structures (rare)
- Risk of clot formation (deep vein thrombosis), particularly in lower limb procedures
- General risks related to anaesthesia
- Failure to achieve the expected improvement, or persistence of symptoms
- Involvement of nerve structures — this requires more attention in the elbow than in other joints
- Persistence of stiffness and restricted movement in the elbow
- Persistence of part of the symptoms in tennis elbow
The decision to operate is made by weighing together the duration and severity of symptoms, examination findings, imaging results, age, occupation, activity level and any accompanying conditions. Outcomes vary from person to person.
When Should You Seek Assessment?
- If the elbow does not fully straighten or fully bend
- If there is catching, locking or noise in the elbow
- If numbness or tingling in the hand and fingers accompanies it
- If tennis elbow symptoms have persisted for months
- If pain and loss of movement developed after an injury
Frequently Asked Questions
Is elbow arthroscopy a risky procedure?
Because important nerve and vessel structures run around the elbow, the choice of portals and technical care are of particular importance. Performed with appropriate technique it is a widely used method; nevertheless, as with every surgical procedure, it carries risks, and your individual assessment is made after examination.
Should I have surgery straight away for tennis elbow?
No. The first approach in tennis elbow is not surgical; an exercise programme, activity modification and pain management are applied first. Surgery is considered in cases that persist for a long time and do not respond to these treatments.
What causes locking in the elbow?
One of the most common causes is loose bodies within the joint; a fragment of cartilage or bone can lodge between the joint surfaces and block movement. A complaint of locking is a finding that should be assessed.
Will my elbow become stiff after the operation?
The elbow is prone to stiffness when left immobile for long periods. For this reason an early, controlled movement programme is started in most cases. Adherence to the programme is an important determinant of the outcome.
Can numbness in my hand come from the elbow?
Yes. The ulnar nerve runs superficially on the inner side of the elbow and can be compressed there; this may cause numbness in the ring and little fingers. The neck and wrist are also assessed for differential diagnosis.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of elbow arthroscopy and upper limb surgery and related areas of arthroscopic surgery. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Arthroscopic Surgery (Keyhole Joint Surgery)
- Shoulder and Upper Extremity
- Tennis Elbow and Golfer’s Elbow (Epicondylitis)
- Hand and Wrist Surgery
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any surgical or medical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.