Arthroscopy is basically a surgical procedure which orthopedic surgeons generally use to visualize, diagnose & treat problems located inside a joint. Word arthroscopy originates from two Greek words. ‘Arthro’ which means a joint & ‘Skopein’ meaning to look into; Term Arthroscopy thus literally means to look within joints. The orthopedic surgeon will make a small incision in the patient’s skin near the joint during arthroscopic examination. The surgeon will then insert pencil-sized instruments which contain a lighting system & small lens which is meant to magnify & illuminate the structures inside the joint. Light is transmitted to the end of arthroscope inserted into the joint through fiber optics. Attaching the arthroscope with a miniature television camera, the orthopedic surgeon is able to see the interior of the joint through very small incisions rather than large sized incisions which is needed in conventional type of surgery. Television camera which is attached to the arthroscope will display images of the inside of joints on a television screen. This will allow the orthopedic surgeon to look throughout the inside of the joint during the operation. The surgeon will clearly be able to see the ligaments & cartilage inside of joints & so can effectively determine the amount & type of injury which is required to be repaired or corrected as necessary.
Why Undergo Arthroscopy?
Diagnosing disease & injuries to joints begins with a thorough medical history alongside physical examination & x-ray tests. Additional imaging tests like CT (computed tomography) scan or MRI (magnetic resonance imaging) may also be needed. However, final diagnosis is made through the arthroscope & which may be more accurate than it would have been possible through x-ray studies or open surgery. Injuries & disease can often damage tendons, muscles, ligaments, cartilage & bones. Some of the most common conditions found during arthroscopic investigation of joints include the following.
Like for example, synovitis is inflammation of the lining inside ankle, wrist, elbow, shoulder or knee.
- Shoulder – This involves recurrent dislocations, impingement syndrome & rotator cuff tendon tears.
- Knee – This includes cartilage (meniscal) tears, wearing or injury of cartilage cushion (chondromalacia) & anterior cruciate ligament tear with instability.
- Wrist – Generally, carpal tunnel syndrome.
- Loose Bodies of Bones and/or Cartilage – For example of wrist, ankle, elbow, shoulder or knee.
Some problems which are normally associated with arthritis can also be treated through arthroscopic surgery. Many procedures also combine standard & arthroscopic surgeries.
- Removal of loose cartilage or bone in wrist, ankle, elbow, shoulder & knee
- Repair of torn ligaments
- Rotator Cuff Surgery
- Release of carpal tunnel
- Resection or repair of torn meniscus (cartilage) from shoulder or knee
- Removal of inflamed synovium lining in ankle, wrist, elbow, shoulder & knee
- Reconstruction of anterior cruciate ligament in knee
Though all joints can be effective viewed & investigated with help of an arthroscope, there are six joints which are most frequently examined with help of this instrument. These include wrist, hip, ankle, elbow shoulder & knee. With advances made in fiber-optic technology, newer techniques are now available to orthopedic surgeons & so other joints may also be treated in near future.
Types of Arthroscopy Procedures
Common types of arthroscopic surgeries include the following.
This is a surgical technique which is meant to diagnose & treat problems which are associated with the knee joint. For this procedure, surgeons will make a very small incision near the knee & insert a tiny camera called arthroscope in the joint during the procedure. The arthroscope will allow the surgeon to view inside of the knee joint on a monitor screen. Subsequently, surgeons will investigate the problem with the knee & if required will also correct the issue with help of small tools within the arthroscope, at the same time. Arthroscopy can diagnose many knee problems including misaligned patella (kneecap) or a torn meniscus. This procedure can also repair ligaments of the knee joint. While there are limited risks to knee arthroscopy, the outlook is good for most cases. Recovery time & prognosis will, however, depend upon the severity of knee problem & complexity of the procedure which is required.
Using a tiny camera called arthroscope to probe or repair tissues inside & around the shoulder joint, shoulder arthroscopy is an excellent procedure for rotator cuff repair. Rotator cuff is basically a group of muscles which form a cuff over the shoulder joint. These tendons & muscles hold the art in shoulder joint & help movement of shoulders in different directions. Tendons located inside the rotator cuff can sometimes tear due to overuse or injury. Most patients are likely to receive general anesthesia prior to this surgery. This means that the patient will be asleep during the procedure, & will therefore not feel any pain. while some patients may receive regional anesthesia in which the shoulder & arm area will be numbed so that there is no feeling of pain. Patients receiving regional anesthesia will also be given medications so as to comfort & feel sleepy during the operation.
Hip arthroscopy is also a surgical intervention which permits surgeons to view inside the hip joint without the need of making any large incisions through skin & soft tissue. Arthroscopy is generally useful in diagnosing & treating a wide range of hip joint problems. The orthopedic surgeon will insert the small arthroscope camera into the hip joint during hip arthroscopy procedure. Subsequently, this camera will display pictures on a video monitor screen & the surgeon will use these images to guide miniature surgical tools during the operation. Since arthroscope & surgical tools are thin, the surgeon can use small sized incisions, rather than large incisions which are required for open surgery. This eventually results in lesser pain, lesser joint stiffness & shorter time for recovery & return to normal activities. Although hip arthroscopy has been performed for several years, it has not been as common as shoulder or knee arthroscopy.
This is relatively a very safe surgical procedure with low rates of complications.
- Since infection is a risk, the procedure involves introduction of tiny instruments to a typically sterile area.
- Bleeding from blood vessels which are accidentally cut may sometimes occur.
- Some patients experience local nerve damage which can numb the overlying skin.
- Depending upon the type which is chosen, there are risks involved with any type of anesthesia.
Elbow joint connects the forearm bone with the upper arm bone. Incisions made for elbow arthroscopy operation are small & therefore disrupt lesser soft tissue than the conventional open surgery procedure. Elbow arthroscopy also causes minimum amount of stiffness, swelling & pain alongside faster recovery. Elbow arthroscopy can be useful in diagnosing & treating a variety of conditions including the following.
- Tennis Elbow
- Loose Bodies in Elbow Joint
Fractures & other injuries to the elbow can often lead to significant stiffness of the joint. Elbow arthroscopy can effectively release stiff & contracted elbows. Even though arthritis of the elbow is not curable with elbow arthroscopy, elbow joint can enjoy significant improvement in symptoms & function following this procedure. Orthopedic surgeons may therefore recommend elbow arthroscopy procedure for treatment of elbow disorders following physical examination including x-rays, MRI, CT scans & other imaging studies.
This surgical intervention allows doctors to see inside the wrist joint during the operation. Usually performed after patients sustain injuries like a fall or twisting of wrist & subsequently experiencing pain, swelling or clicks. These symptoms normally mean that there is an internal problem with the wrist joint. Wrist arthroscopy is most often the best method involving direct observation of the injury & repairing it at the same time. This procedure can also be utilized to align fractures of the wrist, remove ganglions, washing out infections & for removing excessive joint linings which are associated with inflammation from conditions such as rheumatoid arthritis. In the last 5 years, wrist arthroscopy has become the third most common joint procedure after shoulder & knee arthroscopy. Moreover, since the incisions involved in this procedure are smaller & typically disrupt lesser soft tissue than conventional open surgery, stiffness, swelling & pain are typically minimal along with recovery that is much faster.
Although arthroscopy surgery is much easier in terms of recovery than the conventional open surgery, it still requires the use of anesthesia & special equipment in the operating room. For this procedure patients will be given local, spinal or general anesthesia, depending upon the condition of the joint or the suspected problem. A small incision, which is about the size of a buttonhole, is made for inserting the arthroscope. Few other incisions will also be made for inserting other special tiny sized operating instruments. Corrective surgery is performed when indicated with help of these specially designed instruments inserted into joints through accessory incisions. Arthroscopy was initially only a diagnostic tool utilized for planning traditional open surgery. However, with the development of advanced instrumentation & surgical techniques, several conditions are now treated using arthroscopic surgery. Like for example, surgeons would insert miniature scissors in order to trim torn meniscus. Most meniscal tears inside knee can be successfully treated through arthroscopic surgery. Small incisions made for the purpose of surgery will be stitched & covered with a dressing after completion of arthroscopic surgery. Subsequently, patients will be moved from operating room to a recovery room & will need little or no pain medications while healing. Patients will also be given instructions on how to care for incisions before being discharged along with guidance as to which activities should be avoided & what exercises they should be doing in order to aid recovery. Surgeons will subsequently inspect the incision site, remove sutures & discuss a rehabilitation program during follow-up visits. Amount of surgery which is required & time for recovery will, however, depend upon the complexity of the patients’ problem. Sometimes during arthroscopy procedure surgeons discover that injury or disease cannot be adequately treated with arthroscopy alone & so extensive open surgery may be performed while the patient is still anesthetized or open surgery may be performed at a later date after having it discussed with the patient.
Although risks & complications associated with arthroscopic surgery are uncommon, complications do sometimes occur during or after the procedure. These include damage to nerves or blood vessels, excessive bleeding or swelling, blood clots in veins (phlebitis), infection & instrument breakage are most common but found to occur in much less than even one percent of all arthroscopic surgery procedures.
Arthroscopic surgeries have received plenty of public attention since it has been used for treating well-known athletes. However, it is an extremely valuable treatment procedure for all orthopedic patients & which generally makes it easier for the patient when compared with conventional open surgery. Moreover, most patients undergo arthroscopic surgery procedures as outpatients & are therefore able to get back home within some hours following operation.
Small sized incision wounds made for arthroscopic surgery may take several days to heal. Most often operative dressings are removed on the morning following surgery & only adhesive strips are applied to cover incisions which heal gradually. Even though incision wounds are small in size & pain within the joint which underwent arthroscopic surgery is minimal, it still requires several weeks for joints to maximally recover. Doctors would suggest specific activities & rehabilitation programs so as to speed up recovery & protection of future joint function. Moreover, it is not unusual for arthroscopic surgery patients to get back to school or work or resume everyday activities within a few days time. Athletes & other patients who are maintaining good physical health conditions in some cases also are able to return to athletic activities within a few weeks time. It should, however, be kept in mind that people undergoing arthroscopic surgery have several different diagnoses including preexisting health conditions, therefore each patients’ arthroscopic surgery is unique to that individual. This is why recovery time will invariably reflect patients’ individuality.
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