ARTHROSCOPY & SPORTS MEDICINES

Shoulder

Arthroscopy

Arthroscopy is a surgical procedure by which the internal structure of a joint is examined for diagnosis and/or treatment using a tube-like viewing instrument called an arthroscope. Arthroscopy was popularized in the 1960’s and is now commonplace throughout the world. Typically, it is performed by orthopedic surgeons in an outpatient setting. When performed in the outpatient setting, patients can usually return home on the same day the procedure is completed.

The technique of arthroscopy involves inserting the arthroscope, a small tube that contains optical fibers and lenses, through tiny incisions in the skin into the joint to be examined. The arthroscope is connected to a video camera and the interior of the joint is seen on a television monitor. The size of the arthroscope varies with the size of the joint being examined. For example, the knee is examined with an arthroscope that is approximately 5 millimeters in diameter. There are arthroscopes as small as 0.5 millimeters in diameter to examine small joints such as the wrist.

If procedures are performed in addition to examining the joint with the arthroscope, this is called arthroscopic surgery. There are a number of procedures that are done in this fashion. If a procedure can be done arthroscopically instead of by traditional surgical techniques, it usually causes less tissue trauma, may result in less pain, and may promote a quicker recovery.

When Is Arthroscopy Considered

Arthroscopy can be helpful in the diagnosis and treatment of many noninflammatory, inflammatory, and infectious types of arthritis as well as various injuries within the joint.

Noninflammatory degenerative arthritis, or osteoarthritis, can be seen using the arthroscope as frayed and irregular cartilage. A new procedure for the treatment of younger patients with an isolated injury to the cartilage covering the bone ends within a joint uses a “paste” of the patient’s own cartilage cells. The cells are harvested and grown in the laboratory and are then reimplanted at a later date in the knee with the use of an arthroscope.

In inflammatory arthritis, such as rheumatoid arthritis, some patients with isolated chronic joint swelling can sometimes benefit by arthroscopic removal of the inflamed joint tissue (synovectomy). The tissue lining the joint (synovium) can be biopsied and examined under a microscope to determine the cause of the inflammation and discover infections, such as tuberculosis. Arthroscopy can provide more information in situations which cannot be diagnosed by simply aspirating (withdrawing fluid with a needle) and analyzing the joint fluid.

Arthroscopy is commonly used in the evaluation of knees and shoulders but can also be used to examine and treat conditions of the hips, wrist, ankles, feet, spine, and elbows.

Preparation

Arthroscopy is essentially a low blood loss procedure and generally has few complications. The underlying health of the patient is considered when determining who is a candidate for arthroscopy. Most importantly, the patient should be able tolerate the anesthetic that is used during the procedure. A person’s heart, kidney,liver, and lung function should be adequate. If there are existing problems such as heart failure oremphysema, these should be optimized as possible prior to surgery. Patients who are on anticoagulants (blood thinners) should have these medications carefully adjusted prior to surgery. Other medical problems should also be controlled prior to surgery, such as diabetes and high blood pressure.

Preoperative evaluation of a patient’s health will generally include a physical examination, blood tests, and aurinalysis. Patients who have a history of heart or lung problems and generally anyone over the age of 50 will usually be asked to obtain an electrocardiogram (EKG) and a chest X-ray. Any signs of ongoing infection in the body usually postpones arthroscopy, unless it is being done for possible infection of the joint in question.

Performing

Arthroscopy is most often performed as an outpatient procedure. The patient will check into the facility where the procedure is being performed and an intravenous line (IV) established in order to administer fluids and medication. The type of anesthesia used varies depending on the joint being examined and the medical health of the patient. Arthroscopy can be performed under a general anesthetic, a spinal or epidural anesthetic, a regional block (where only the extremity being examined is numbed), or even a local anesthetic. If a general anesthetic is not used, the patient is often sedated.After adequate anesthesia is achieved, the procedure can begin. An incision is made on the side of the joint to be examined and the arthroscope is inserted into the incision. Other instruments are sometimes placed in another incision to help maneuver certain structures into the view of the arthroscope. In arthroscopic surgery, additional instruments for surgical repairs are inserted into the joint through additional small incisions in the joint. These instruments can be used to cut, remove, and suture (sew) damaged tissues. Once the procedure is completed, the arthroscope in removed and the incisions are sutured closed.

Recovery

Immediately after arthroscopic surgery, patients may be sleepy, especially if a general anesthetic or sedation has been used. Medications are administered to control pain if needed. If a local anesthetic has been used, there may be no pain at all immediately after the procedure. If a spinal or regional anesthetic has been used, there can be numbness and weakness of the extremity that gradually resolves before the patient is sent home.

The surgical incisions from arthroscopy are small. They usually consist of several 5 mm (1/4 inch) incisions on either side of the joint, which are bandaged after surgery. The bandage may absorb some of the tissue drainage from these wound sites. Patients should notify their physician’s office immediately if they develop unusual joint pain, swelling, redness or warmth, or if they injure the involved joint.

Facts On Arthroscopy

  • Arthroscopy is a surgical procedure that can be performed for diagnosis and/or treatment of joint abnormalities.
  • Arthroscopy is most often an outpatient procedure.
  • Arthroscopy can be performed using general, spinal, regional, or local anaesthetic.
  • The surgical incisions required for arthroscopy are several, approximately ¼ inch, on either side of the joint.
  • Complications during and after most arthroscopic procedures are rare but possible. These unlikely effects may include blood clots, infection, joint stiffness, and nerve or blood vessels damage.
  • The post-surgery rehabilitation requirements will depend on the procedure performed. Patients should inquire about the anticipated rehabilitation needs associated with their specific procedure and condition.
Knee

What are the possible complications associated with arthroscopy?

Some of the possible complications after arthroscopy include infection, phlebitis (clotting of blood in vein), excessive swelling, bleeding, blood vessel, or nerve damage and instrument breakage.

What is the recovery process after arthroscopic surgery?

It may take several weeks for the puncture wounds to heal and the joint to recover completely. A rehabilitation program may be advised for a speedy recovery of normal joint function. You can resume normal activities and go back to work within a few days. You may be instructed about the incision care, activities to be avoided, and exercises to be performed for faster recovery.

Will physical therapy be required after surgery?

Getting a full range of motion, strength, and flexibility back after surgery usually takes time. That is where pre-operative exercise, education, and post-operative physical therapy programs come in – to ensure you are physically and emotionally prepared for surgery and to maximize your recovery after surgery.

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