Test Overview
Arthroscopy is a surgical procedure that
allows your doctor to look at the inside of a joint in your body through a thin
viewing instrument called an arthroscope. Arthroscopy allows your doctor to
look at the joint surfaces and the surrounding soft tissues, such as tissue
that connects bone to bone (ligaments) and the tough tissue that
covers the ends of the bones at the joints (cartilage) and
provides a cushion between the bones. This procedure can be used to diagnose a
joint problem, perform surgery that repairs a joint problem, remove a loose or
foreign body, or monitor a disease or the effectiveness of a treatment.
Arthroscopy is commonly performed on the knee, shoulder, and ankle. It also can
be done on the hip, elbow, and wrist.
During arthroscopy, the
arthroscope is inserted into your joint through a small cut (incision) in the
skin. The arthroscope has a light source and a video camera attached to it.
Images from the camera can be seen on a video monitor. These magnified images
provide a clear picture of your joint. A sample of joint tissue can be
collected during arthroscopy for biopsy. If surgery is done, additional
instruments will be inserted into your joint through other small
incisions.
See a picture of
arthroscopy of the knee.
Like open
surgery (which is done using a larger incision), arthroscopy allows your doctor
to see what is wrong with your joint. But compared to open surgery,
arthroscopy:
- Is usually less painful.
- Is usually less
costly.
- Usually allows for a quicker recovery time, depending on
what is done.
- Can be done on an outpatient basis without requiring
an overnight stay in a hospital. Open surgery often requires an inpatient stay
in the hospital.
Why It Is Done
Arthroscopy
is
used to:
Examples of when arthroscopy is used to perform
surgery:
- Bone tissue can be shaved to remove calcium
deposits or bone spurs.
- Soft tissues (such as ligaments, tendons,
or cartilage) can be repaired or trimmed.
- Ligaments can be cut,
repaired, or reconstructed.
- Cutting or releasing a tight ligament
may allow increased range of motion for a stiff joint.
- A sample of
joint tissue or joint fluid (synovial fluid) may be collected for laboratory
analysis (biopsy).
- Scar tissue or an area of joint lining
(synovium) that is inflamed can be removed.
Some joint problems may sometimes be repaired using a
combination of arthroscopy and open surgery.
How To Prepare
Arthroscopy is often done on an
outpatient basis without requiring an overnight stay in a hospital.
Tell your doctor if you:
- Have allergies to any medicines, including
anesthetics.
- Are taking any medicines,
including blood-thinning medicines (such as warfarin [Coumadin]) or
aspirin.
- Have had any bleeding problems, including blood clots in a
vein (deep vein thrombosis, or DVT).
- Are or might be pregnant.
- Have a history
of joint stiffness or
arthritis. Joint damage caused by arthritis may make
it difficult or impossible to do this procedure.
- Have had an X-ray
of your joint that used
contrast material (arthrogram) within the previous 10
days. The contrast material may cause inflammation within your joint that makes
performing arthroscopy difficult. This inflammation also can prevent a clear
picture of your joint during arthroscopy.
- Have a history of
infection, such as
septic arthritis, in the affected
joint.
- Have a history of a broken bone (fracture) or
injury to the affected joint.
Before the procedure, you will be asked to sign a consent
form. Talk to your doctor about any concerns you have regarding the need for
the test, its risks, how it will be done, or what the results will mean. To
help you understand the importance of this test, fill out the
medical test information form(What is a PDF document?).
You may have more tests, such as
blood tests or urine tests, before your arthroscopy.
Arrange to
have someone drive you home after the procedure.
If you have
arthroscopy of your ankle, knee, or hip, your doctor will talk to you about
having crutches available after the procedure. If you have arthroscopy of a
joint in your arm, you will likely wear a sling or splint after the
procedure.
How It Is Done
Arthroscopy is usually done by a doctor
who specializes in bone, muscle, and joint surgery (orthopedic surgeon).
You will be asked to remove any jewelry and to wear a hospital gown. You
may be given a sedative shortly before the procedure to help you relax. The
skin around your joint may be shaved.
If
general or regional is used, an
anesthesia specialist will administer the medicine.
A general anesthetic will make you unconscious during the procedure. Your heart
rate and rhythm, blood pressure, and respirations will be monitored during the
procedure. If a
local anesthetic is used, it will be injected into the
skin and joint space. If a local or regional anesthetic is used, your limb will
be numb and you will be relaxed and drowsy but will remain conscious.
You usually lie on your back. Depending on which joint is being looked
at, an inflatable band (tourniquet) may be used to temporarily restrict blood
flow to your joint so your doctor can see all the structures in your joint.
Your joint is scrubbed with an antiseptic solution and draped with sterile
towels. Before the tourniquet is inflated, the joint will be elevated and may
be wrapped with an elastic bandage to reduce blood flow to the joint.
A small incision about
0.25 in. (0.6 cm) will be made
near your joint. Before inserting the arthroscope, an irrigation solution
(usually saline) will be used to flush the joint space to provide a better view
of the entire joint. A steady low flow of solution is usually used during the
procedure to clear out any debris or blood in the joint so your doctor can
evaluate your joint.
Once the arthroscope is inserted, your doctor
will be able to see inside the joint by viewing a video monitor attached to the
arthroscope. Your doctor or the surgical assistants may bend, extend, and
reposition the joint to see it from different angles. Videotapes or photographs
of the joint may also be taken.
If additional surgery is required
to repair your joint problem, more small incisions will be made and other thin
instruments will be inserted into your joint. When the arthroscope and any
other instruments are taken out, any blood and debris will be flushed with
saline and drained. To reduce inflammation or pain, local anesthetics or
corticosteroids may be injected into your joint.
The small incision is closed with stitches. Depending on which
joint was looked at, you may need to use splints, slings, or crutches to
support movement of your joint during recovery.
After the
procedure, you may need to rest your joint for several days. You may not be
able to drive for 24 hours after the procedure, depending on which joint was
looked at and what type of anesthetic you had. If your stitches are not
absorbable, they will be removed in 7 to 10 days. Ice, elevation, and a
compression bandage may be used to reduce any swelling, and pain relievers may
be used to relieve any pain or discomfort. Ask your doctor for advice on
strengthening your joint with exercise and when you can resume normal activity.
The time arthroscopy takes depends on what is done. It may take
only about 15 minutes but it could take an hour or longer.
How It Feels
If you are given a local anesthetic
before the procedure, you will feel a temporary burning or stinging sensation
in your skin. As the arthroscope is inserted into the joint, you will feel a
thumping sensation. You may feel slight pulling sensations in the joint area as
your doctor moves joint structures around.
If you are given a
general anesthetic before the procedure, you will be unconscious and will not
feel anything during the procedure. If you are given a regional anesthetic,
your arm or leg will be numb for several hours.
You may have some
soreness and pain after the procedure. Your doctor will give you instructions
on using pain medicine and applying ice to your joint (and possibly to elevate
it) to reduce swelling and pain. Keep the bandages that cover your incision
clean and dry.
After arthroscopy, you may notice bruising of your
skin around the incision. This is temporary and should disappear within 2
weeks. It is normal for your joint to feel tender for about a week. Ask your
doctor how much bleeding, drainage, or swelling from the incision site to
expect. If you needed more extensive joint surgery, you may have more bleeding,
drainage, pain, and swelling, and it may last longer than a more simple
surgery.
Risks
Complications are not common during arthroscopy.
Sometimes there is joint stiffness or long-lasting joint pain. Bleeding within
the joint can occur, particularly if surgery is done during the
procedure.
There is a small chance of infection, formation of a
blood clot in the affected limb, or nerve or joint damage. Also, there is a
small risk of damage to the structures within the joint.
In rare
cases, a serious condition called
compartment syndrome can occur if pressure builds
within a muscle compartment (most commonly in the front of the calf or
forearm). When this occurs, immediate medical treatment is needed to release
the pressure.
In very rare cases, death can occur from
complications of general anesthesia.
After the test
Contact your doctor immediately
if:
- Your pain or swelling (or both) continue or
get worse.
- Your incision site bleeds excessively.
- You
experience redness, swelling, pain, or a sensation of heat in your calf or arm.
These may be signs of a blood clot in a vein, a condition called
thrombophlebitis. If you have these symptoms, do not
massage the area.
- You develop signs of infection. These signs may
include:
- Increased pain, swelling, redness, or
warmth around the affected area.
- Red streaks extending from the
affected area.
- Drainage of pus from the area.
- Swollen
lymph nodes in the neck, armpit, or groin.
- Fever or chills with no
other known cause.
Results
Arthroscopy is a surgical procedure that
allows your doctor to look at the inside of a joint in your body through a thin
viewing instrument called an arthroscope. Your doctor can determine whether
your joint is normal by looking at it through the arthroscope. Usually your
doctor will be able to discuss the results with you right after the
test.
Arthroscopy
| Normal: |
In a normal, healthy joint, the
ligaments look like white cables. The
cartilage is smooth and white. The joint fluid is
clear, and there are no loose pieces of tissue in the joint. If there is no
damage or disease seen in the joint, your doctor may conclude that your joint
is normal and is not the cause of your symptoms.
|
| Abnormal: |
In a damaged or diseased joint, the
ligaments and cartilage are abnormal in color and shape. If there is damage or
disease in the joint, your doctor may identify the condition and may even
perform surgery during the arthroscopy to repair the joint problem. Examples of
damage or disease in the joint include:
- Torn, displaced, or loose fragments of
soft tissues (such as ligaments or cartilage).
- Abnormal growths,
cysts, or
ganglions.
- Evidence of joint or cartilage
destruction caused by injury or diseases such as
arthritis.
- Infection.
|
After your doctor has evaluated your joint, further
treatment with medicine, physical therapy, or surgery may be
recommended.
What Affects the Test
Reasons you may not be able to
have the test or why the results may not be helpful include:
- Having had an
X-ray of the joint that used
contrast material (arthrogram) within the previous 10
days. The contrast material may cause inflammation within the joint that can
prevent a clear picture of the joint during arthroscopy.
- Having
arthritis. Joint damage caused by arthritis may make it difficult or impossible
to do this procedure.
- Having some other medical conditions, such as
a thickening of tissue (fibrosis) in the joint area or widespread infection
(sepsis).
What To Think About
- Surgical procedures done by arthroscopy usually
result in shorter hospital stays and faster recovery times than open joint
surgery.
- Arthroscopy usually is not done if:
- A skin or wound infection is present near
the joint to be examined. But arthroscopy may be done to clean out an infected
joint.
- Ankylosis is present. Ankylosis is a condition that causes
stiffness and poor flexibility of a joint and may be caused by a disease (such
as
ankylosing spondylitis), a joint injury, or
surgery.
- Joint destruction is severe (for example, with severe
arthritis).
- A severe bleeding disorder is present. But arthroscopy
may be done if clotting factor medicines are used.
- It may take several weeks for your joint to
recover. If extensive surgery is done during your arthroscopy, it may take
longer than a few weeks to recover. Your doctor will give you pain medicine and
recommend rehabilitation exercises or physical therapy for you to do during
your recovery period. Depending on which joint was examined, you may need to
use splints, slings, or crutches to support movement of your joint during
recovery.
- Many doctors use
ultrasound,
computed tomography (CT scan), or
magnetic resonance imaging (MRI) before doing an
arthroscopy to make sure that any problems that need surgery can be done at the
same time as the arthroscopy.
References
Other Works Consulted
- Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis:
Saunders.
- Fischbach FT, Dunning MB III, eds. (2009).
Manual of Laboratory and Diagnostic Tests, 8th ed.
Philadelphia: Lippincott Williams and Wilkins.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
William H. Blahd, Jr., MD, FACEP - Emergency Medicine |
|
Specialist Medical Reviewer
|
Kenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma |
|
Last Revised
|
January 7, 2011 |