What Is Elbow and Wrist Arthroscopy?
Arthroscopy means looking inside a joint. The surgeon makes a few small incisions, often less than half an inch long, and inserts an arthroscope, a thin tube with a camera and light. The camera shows the inside of the joint on a screen. Small instruments placed through the other incisions are used to trim, smooth, remove or repair tissue.
Because the incisions are small, arthroscopy usually causes less disruption to the muscles and skin around the joint than open surgery. It can be used to diagnose a problem that imaging could not fully explain, and to treat it in the same procedure.
In the elbow and wrist, arthroscopy may be used to:
- Remove loose bodies, small pieces of bone or cartilage that float in the joint and can cause catching or locking.
- Remove bone spurs, extra bone growths that limit motion or cause pain.
- Release scar tissue and the tight joint lining (capsule) to improve motion in a stiff elbow.
- Clean up damaged cartilage, the smooth tissue that covers the ends of the bones.
- Treat ligament tears, such as tears of the TFCC (triangular fibrocartilage complex), a cushion of cartilage and ligaments on the pinky side of the wrist.
- Remove some ganglion cysts, fluid-filled lumps that arise from the wrist joint, in selected cases.
- Help guide the repair of some wrist fractures, so the surgeon can check that the joint surface lines up.
- Treat some cases of tennis elbow that have not improved with non-surgical care.
Performed as an outpatient procedure at a hospital or surgery center where our surgeons operate, with evaluation, X-ray and MRI, follow-up visits and hand therapy here in our Boynton Beach office.
Who Is a Candidate?
You may be a candidate if you have elbow or wrist pain, catching, locking, clicking or loss of motion that has not improved with non-surgical care, and your exam and imaging point to a problem inside the joint that arthroscopy can address. Non-surgical care often includes rest, activity changes, splinting, therapy, medication when safe for you and cortisone injections.
Arthroscopy is not right for every problem. Severe arthritis that has worn away most of the cartilage, for example, may be better treated another way. Dr. Tucker will explain what arthroscopy can and cannot do for your joint.
What to Expect
Your evaluation includes an exam and X-rays in our Boynton Beach office, and often an MRI to look at cartilage, ligaments and soft tissue. Dr. Tucker reviews the images with you and explains whether arthroscopy, open surgery or continued non-surgical care fits your situation.
Arthroscopy is usually done as an outpatient procedure at a hospital or surgery center where our surgeons operate, so you go home the same day. Anesthesia may be general anesthesia, a nerve block that numbs the arm, or both. The length of the procedure depends on what needs to be done. You will leave with small bandages and, depending on the repair, a splint or sling.
Risks and Side Effects
Arthroscopy is generally well tolerated, but it carries risks. These include infection, stiffness, swelling, bleeding into the joint, injury to nearby nerves, blood vessels or tendons, which are close to the joint in both the elbow and wrist, incomplete relief of symptoms, and risks from anesthesia or the nerve block. Sometimes what the camera shows means a larger, open procedure is needed. Dr. Tucker will explain the risks that apply to you.
Recovery
Recovery depends on what was done. After removal of loose bodies or bone spurs, many people start moving the joint within days and return to light use within a few weeks. A ligament repair, such as a TFCC repair, often needs a splint or cast for several weeks before motion begins, and full recovery can take several months.
Dr. Tucker coordinates hand and occupational therapy in our office. Our therapists, including Elise Burger, OTR, guide motion and strengthening and can make custom splints. They share your chart with Dr. Tucker, so therapy matches the repair and how you are healing.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
Elbow and wrist arthroscopy is usually covered by Medicare and most commercial PPO plans when it is medically necessary. Many plans require prior authorization, and some want proof of non-surgical treatment first. HMO and managed-care plans require a referral from your primary care physician before your visit. Co-pays, co-insurance and deductibles apply. If your injury happened at work, we accept workers' compensation and coordinate treatment, documentation and return-to-work planning. Call our office to verify your benefits.
When to Talk to a Specialist
Schedule an evaluation if elbow or wrist pain, catching, locking or stiffness lasts more than a few weeks or limits work, sports or daily tasks. After an injury, go to the emergency room or call 911 if the joint looks deformed or your hand is numb, cold or pale. After surgery, go to the emergency room or call 911 if you have fever, spreading redness or drainage from an incision. For other questions after hours, call our main office number to reach the answering service.
