Elbow Arthroscopy
Minimally Invasive Keyhole Surgery
Advanced techniques for faster recovery and better outcomes
Understanding Elbow Arthroscopy
Elbow arthroscopy has evolved significantly over the past decades and is now a valuable tool for treating many elbow conditions. The procedure uses a small camera (4mm or smaller) and specialized instruments inserted through small incisions (portals) to visualize and treat problems inside the joint.
Key Advantages
- • Smaller incisions (4-5mm) versus large open incisions
- • Less soft tissue damage and scarring
- • Better visualization of the entire joint
- • Faster recovery and return to activities
- • Lower infection risk
- • Can be done as outpatient surgery
Technical Considerations
Elbow arthroscopy is technically demanding due to the small joint space and proximity of nerves and vessels. The ulnar nerve, median nerve, and brachial artery are all at risk. It requires specialized training and experience beyond general arthroscopy skills.
Indications
• Loose body removal - Most common indication
• Osteochondritis dissecans - Drilling, fixation, debridement
• Elbow stiffness - Capsular release, osteophyte removal
• Arthritis debridement - Removal of bone spurs, loose fragments
• Tennis elbow - ECRB release (selected cases)
• Synovectomy - Rheumatoid arthritis, PVNS
• Radial head fractures - Assisted reduction and fixation
• Coronoid fractures - Selected cases
• Lateral epicondylitis - Refractory cases
• Posterior impingement - Throwers, gymnasts
• Septic arthritis - Irrigation and debridement
• Diagnostic - When non-invasive tests inconclusive
Portal Placement
Several portals (small incisions) are used to access different parts of the elbow. Safe portal placement is critical to avoid neurovascular injury.
2cm proximal to medial epicondyle, anterior to intermuscular septum
At risk: Medial antebrachial cutaneous nerve, ulnar nerve
2cm proximal and 1cm anterior to lateral epicondyle
At risk: Posterior antebrachial cutaneous nerve, radial nerve
Posterolateral (soft spot) and direct posterior (trans-triceps)
At risk: Posterior antebrachial cutaneous nerve
Safety Note
The elbow is distended with fluid before portal placement to push nerves away from the joint. Maintaining elbow at 90° flexion moves the brachial artery and median nerve further from the anterior capsule.
Common Procedures
Most common indication. Loose bodies cause catching, locking, and pain. Arthroscopy allows thorough inspection of all compartments and removal of fragments that may be missed with open surgery.
Success rate: >90% symptom improvement
For post-traumatic or idiopathic elbow contracture. Anterior and/or posterior capsule is released. Osteophytes are removed. May be combined with open release for severe cases.
Expected improvement: 30-40° increase in arc of motion
For primary OA with mechanical symptoms (catching, locking). Osteophytes (especially olecranon fossa), loose bodies, and inflamed synovium are removed. Good for improving motion; pain relief varies.
Best results: Patients with good joint space, mechanical symptoms
Options include drilling (stimulate healing), debridement and microfracture, fragment fixation, or loose body removal. Approach depends on lesion stability and size.
Return to sport: 4-6 months for most athletes
Complications & Recovery
Potential Complications
Recovery Timeline
Day 1-3
Rest, ice, elevation. Begin gentle finger and wrist motion.
Week 1-2
Begin active elbow ROM. Return to desk work possible.
Week 4-6
Progressive strengthening. Return to light manual work.
Week 8-12
Return to sports and heavy activities (procedure dependent).
Evidence & References
• Andrews JR, Carson WG. Arthroscopy of the elbow. Arthroscopy 1985
• O'Driscoll SW, Morrey BF. Arthroscopy of the elbow: Diagnostic and therapeutic benefits and hazards. JBJS Am 1992
• Kelly EW, et al. Complications of elbow arthroscopy. JBJS Am 2001
• Yeoh KM, et al. Elbow arthroscopy: A systematic review of the literature. Arthroscopy 2012
Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)