The elbow packs three joints, three major nerves and the arteries of the forearm into a few centimeters. Open surgery there means a long incision and weeks of stiffness. Surgeons moved much of it to the arthroscope.
Conditions we treat through small incisions
Six problems account for the work.
Elbow arthroscopy in plain words
The surgeon enters the joint from the side and back of the elbow, along paths chosen to stay clear of the nerves, then looks around the whole joint on a screen before treating anything. Everything that comes out, loose fragments, spurs and inflamed lining, leaves through the same small openings.
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Elbow conditions treated by keyhole surgery
| Condition |
What we do |
Desk work again |
| Loose bodies, a locking elbow |
Remove the fragments |
Within a week |
| Osteoarthritis and stiffness |
Remove spurs and release the tight capsule |
One to two weeks |
| Tennis elbow |
Release the damaged tendon origin |
One to two weeks |
| Ulnar nerve compression |
Endoscopic release of the cubital tunnel |
Within a week |
| Osteochondritis dissecans |
Remove or fix a loose cartilage fragment |
One to two weeks |
| Rheumatoid synovitis |
Remove the inflamed joint lining |
One to two weeks |
Loose bodies and a locking elbow
Pieces of cartilage or bone break off and float in the joint, catching between the surfaces so the elbow suddenly locks and hurts. Removing them through the arthroscope gives quick relief, and the surgeon looks for the source, an arthritic spur or a cartilage defect, and treats it in the same sitting.
1
Anesthesia and nerve block
General anesthesia, with a block that keeps the arm numb into the night.
2
Portals
The joint is filled with saline, and the surgeon makes the small entry points, checking the position of each nerve along the way.
3
Treatment
From thirty minutes for a loose body to two hours for a stiff arthritic elbow.
4
Closure
Single stitches or adhesive strips, a soft dressing and, after a release for stiffness, a pump that moves the elbow gently in bed.
Arthritis and the stiff elbow
Elbow arthritis grows bone spurs at the tip of the joint, front and back, which block the last part of bending and straightening and hurt when they hit. Arthroscopic osteocapsular arthroplasty removes the spurs and releases the thickened capsule, and a study of 56 patients followed for a mean of five years measured what that achieves.
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Arthroscopic osteocapsular arthroplasty, 56 patients
| Measure |
Before surgery |
Around six months |
Five years |
| Arc of motion |
89 degrees |
112 degrees |
105 degrees |
| Pain, 0 to 10 |
4.9 |
2.0 |
1.4 |
| Mayo elbow score, out of 100 |
62 |
84 |
88 |
Why some motion slips back
Motion peaked in the first year and fell by around six degrees over the following years as arthritis continued, while pain and function kept improving. The operation removes what blocks the joint and does not stop arthritis, and we say so before surgery.
Who benefits most
Pain at the end of bending or straightening points to spurs. So does a hard block, the feeling of bone meeting bone before the arm is fully straight. Those patients gain most, because the arthroscope removes exactly what stops the joint, while pain through the whole arc of movement, at rest and at night, points to cartilage worn down across the joint surface, where a cleanout does far less and a replacement or a fusion becomes the question for the years ahead. A CT scan settles it. Ask for one.
Tennis elbow
Tennis elbow comes from wear in the tendon that starts at the outer bone of the elbow, and nine of ten cases settle without surgery within a year or two. We operate only when pain persists after six to twelve months of the steps below.
1
Load less
Cut back the gripping and lifting that hurt, and use a forearm strap for heavy tasks.
2
Physiotherapy
Slow strengthening exercises for the wrist extensors, daily for three months, with a physiotherapist checking the technique.
3
Time
Six to twelve months in all.
What the trials show
With the number of available participants, this study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB over placebo surgery for the management of chronic tennis elbow.
Randomized placebo-controlled trial, 26 patients, American Journal of Sports Medicine, 2018
Open, arthroscopic or percutaneous release
A review of 1,604 operations compared the three. Complications ran at 3.8 percent after open, 2.9 percent after arthroscopic and 3.9 percent after percutaneous release, with satisfaction at 94, 89 and 88 percent. Arthroscopic and percutaneous release hurt less afterward, and open and arthroscopic release gave better function scores than percutaneous release.
However, open techniques were correlated with higher surgical-site infection rates than arthroscopic techniques (0.7% vs 0%, P = .04).
Systematic review of 1,604 tennis elbow operations, Arthroscopy, 2017
How we read this
Our approach to tennis elbow surgery
In the placebo trial, patients who had only a skin incision improved as much as those who had the tendon removed, though the trial stopped early with small numbers. We take that seriously. Surgery comes last, after a full course of physiotherapy, and we tell patients plainly that time and rehabilitation do much of the work.
Osteochondritis dissecans in young athletes
Gymnasts and baseball pitchers between ten and sixteen can lose blood supply to a patch of bone under the cartilage on the outer side of the elbow. Early lesions heal with rest. Loose or unstable fragments come out through the arthroscope, or the surgeon fixes them back in place, and young athletes return to sport over three to six months.
Endoscopic ulnar nerve release
The ulnar nerve runs behind the inner bone of the elbow, the funny bone, through a tunnel of ligament and muscle. When the tunnel tightens, these signs follow.
- Numbness or tingling in the ring and little fingers.
- Symptoms worse with the elbow bent, on the phone or at night.
- Weak pinch, clumsy fingers, dropping things.
- In late cases, wasting of the muscle between thumb and index finger.
655 patients, the same result
Buchanan and colleagues pooled five studies comparing endoscopic and open release. Good or excellent results and pain relief came out the same. Scar tenderness and elbow pain after surgery were far less common after the endoscopic route, bruising under the skin more common, and reoperation ran at 4.9 and 4.1 percent.
The authors demonstrated equivalent overall clinical improvement between endoscopic and open cubital tunnel release in terms of Bishop score and visual analogue scale score reduction.
Meta-analysis of 655 patients, Plastic and Reconstructive Surgery, 2018
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Endoscopic against open cubital tunnel release
| Outcome |
Endoscopic |
Open |
| Good or excellent result |
No difference |
No difference |
| Scar tenderness or elbow pain |
Lower, odds ratio 0.19 |
Higher |
| Hematoma under the skin |
Higher, odds ratio 5.7 |
Lower |
| Reoperation |
4.9 percent |
4.1 percent |
When we move the nerve
If the nerve slips over the bone each time the elbow bends, a simple release leaves it snapping and sore, and the surgeon moves it to the front of the elbow through an open incision. A nerve conduction test before surgery shows how badly the nerve is compressed and sets expectations, since numbness of long standing recovers slowly and wasted muscle may not recover fully.
Risks of elbow arthroscopy
In the Mayo Clinic series of 473 arthroscopies, four joints became infected, 0.8 percent, and minor problems followed 11 percent, among them leaking portals and twelve temporary nerve palsies that all recovered. Rheumatoid arthritis and a stiff contracted elbow raised the risk to the nerves, because the joint has less room and the nerves sit closer, and for those patients the surgeon identifies and protects the ulnar nerve through a small incision before entering the joint.
Recovery after surgery
Movement starts the day after surgery for almost every operation in this guide, because an elbow left still stiffens fast.
Stiffness sets in within days.
Week by week
Days one to three, the dressing stays on and you bend and straighten the elbow several times an hour within comfort. By the end of the first week, light daily use and desk work. Stitches come out at ten to fourteen days. After a release for stiffness, physiotherapy runs daily for six weeks, sometimes with a night splint holding the elbow straight. Lifting and sport return between six weeks and three months, depending on the operation.
The stay in Istanbul
Loose body removal and nerve release go home the same day or the next morning. Arthroscopic release for stiffness keeps you one or two nights for pain control and early movement, and we suggest seven to ten days in Istanbul for physiotherapy and the wound check before you fly. The cost depends on the operation and the physiotherapy days, and the written estimate after the free review lists both.
Pack shirts that button down the front.
A companion, a language and the hotel
Bring one person if you can, since the arm is numb for the first night and dressing one-handed takes practice. A bed for them sits in your room. Coordinators who speak English, Arabic, French, Russian, Serbian, Romanian or Spanish book the hotel next to the hospital, sit in on the consultation and arrange interpreters for any other language.
Call the team the same day
Redness, heat or leaking from a portal, a temperature of 38 degrees or more, numbness in the hand that lasts beyond the first day, or a swollen, tight forearm with pain that keeps rising.
What to send for a free review
X-rays of the elbow from the front and side, any MRI or CT, a nerve conduction report for ulnar nerve symptoms, and a few lines on your pain, what you cannot do and what you have tried. An orthopedic surgeon reviews the file, and the coordinator replies in your language.
Follow-up after you return home runs through your coordinator, who keeps the same WhatsApp number from the first message to the last X-ray and passes every question straight to the surgeon who operated on you.
- A short phone video of your elbow bending and straightening at two weeks and again at six weeks, which the surgeon reviews and answers with any change to the plan.
- A written exercise plan.
- An X-ray at three months after arthritis surgery.
Minimally invasive elbow surgery FAQ
Is elbow arthroscopy safe?
Serious complications are rare. In 473 operations at the Mayo Clinic, 0.8 percent developed a joint infection and no nerve injury was permanent.
Will arthroscopy fix my arthritic elbow?
It removes spurs and frees the joint, and patients in a five-year study kept a gain of 16 degrees of motion and much less pain. It does not replace worn cartilage.
Does tennis elbow need surgery?
Rarely. Nine of ten cases settle with time and physiotherapy, and a placebo-controlled trial found no extra benefit from removing the damaged tendon.
How long will I stay in Istanbul?
One to three days for a loose body or nerve release, seven to ten days after a release for a stiff elbow.
Can I travel alone?
You can, though a companion helps for the first night while the arm is numb. One person can sleep in your room throughout.
References
- Kelly EW, Morrey BF, O'Driscoll SW. Complications of elbow arthroscopy. Journal of Bone and Joint Surgery (American Volume). 2001;83(1):25-34.
- So SP, Kwak JM, Lee JB, et al. Serial changes in clinical outcomes after arthroscopic osteocapsular arthroplasty for primary elbow osteoarthritis: a medium-term follow-up study. Orthopaedic Journal of Sports Medicine. 2023;11(5):23259671231162398.
- Kroslak M, Murrell GAC. Surgical treatment of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. American Journal of Sports Medicine. 2018;46(5):1106-1113.
- Pierce TP, Issa K, Gilbert BT, et al. A systematic review of tennis elbow surgery: open versus arthroscopic versus percutaneous release of the common extensor origin. Arthroscopy. 2017;33(6):1260-1268.
- Buchanan PJ, Chieng LO, Hubbard ZS, Law TY, Chim H. Endoscopic versus open in situ cubital tunnel release: a systematic review of the literature and meta-analysis of 655 patients. Plastic and Reconstructive Surgery. 2018;141(3):679-684.
