Arthroscopy: Reasons, Procedure and Benefits

Introduction-

Arthroscopy is a surgical technique in which a tube-like instrument is inserted into a joint to inspect, diagnose, and repair tissues.

Arthroscopy is advised if you have inflammation in a joint, in cases of injury or trauma to a joint, or have damaged a joint due to wear and tear. You can have arthroscopy on any joint. Most often, it’s done on the knee, shoulder, elbow, ankle, hip, or wrist.

Reasons for damage of joints –

  • Osteoarthritis is the most common form of arthritis.
  • Gout is a type of inflammatory arthritis that occurs in some people with high levels of uric acid in their blood.
  • Septic Arthritis – a condition in which a joint becomes infected,
  • Viral Arthritis – arthritis due to viral infection
  • Rheumatoid Arthritis – RA is a chronic, autoimmune disease
  • Spondylarthritis – An inflammatory rheumatic disease
  • Systemic Lupus Erythematosus – joint inflammation, especially of the knees, wrists, and finger joints, is common in systemic lupus erythematosus
  • Fibromyalgia –  The predominant symptom of fibromyalgia, a chronic pain condition, is widespread muscle tenderness, along with crippling fatigue.
  • Hemarthrosis – A bleeding into a joint due to a number of reasons including trauma.

An Overview

Arthroscopic surgery can treat inflammation, torn ligaments and tendons, loose bones or cartilage issues. If you have a joint issue, there is a good chance arthroscopic surgery can diagnose and treat it. While knee and shoulder arthroscopies are the most common surgeries, the procedure can be performed on any joint.

It can be used to treat conditions of knees, shoulders, ankles, elbows, wrists like:

  • Tendonitis Bursitis
  • Arthritis
  • Frozen shoulder
  • Cartilage damage
  • Bone spurs
  • Arthrofibrosis
  • Ganglion cysts
  • Ligament injury
  • Fractures

Arthroscopy Procedure-

Preparation of patient-

Many doctors will recommend a tailored preparation plan, which includes gentle exercises and medications

The patient may need to stop eating up to 12 hours before the procedure, especially if general anaesthesia has to be applied

Positioning and Scope Insertion

  • The type of anesthetic used to numb pain will depend on the extent of the arthroscopy.
  • A doctor may inject a local anaesthetic to numb the affected joint. In some cases, doctors will use a general anesthetic. In this case, the person will be completely asleep during the procedure
  • The procedure starts with a few small cuts in the joint. Surgeons use a pump to push saline solution into the area. This will expand the joint, making it easier for the doctors to view the affected area and operate it with ease
  • The patient is placed supine with ability to flex the joint.
  • The medical team places a tourniquet (important for safety, but often not inflated).
  • The doctors then make anterolateral incision over a soft spot of the joint. Vertical incisions have the advantage of increased superior-inferior mobility of instruments and   horizontal incisions have advantage of increased medial-lateral mobility of instruments.
  • Next, the doctors insert a trocar into a capsule
  • Advance blade into the capsule with the trocar
  • Advance trochar into suprapatellar pouch to strengthen or fix the joint

Benefits of Arthroscopy

While every surgery is different and every person responds to surgery differently, arthroscopic surgery tends to have many advantages over traditional surgery.

  • Lesser complications: Since arthroscopy uses tiny incisions instead of large cuts, the chance of infection or other complications is much less.
  • Less post-operative pain: No muscles or tendons have to be cut to repair the joint, so pain is usually much more manageable. Fewer cuts also mean that recovery goes much quicker.
  • There is less scarring: The minimally invasive nature of arthroscopic surgery means that scarring is kept to a minimum.
  • Recovering from arthroscopy is usually quicker than recovering from open surgery.
  • Most people leave the hospital on the day of the operation with specific instructions about how to handle recovery. Arthroscopically treated patients tend to heal faster and begin rehabilitation earlier and, subsequently, return to normal activity and work sooner.

General recovery tips include:

  • Applying ice packs to the dressing and surrounding area to reduce swelling and pain
  • Keeping the leg elevated for several days after surgery
  • Resting well and often
  • Changing the dressing regularly
  • Using crutches and following the doctor’s recommendations about applying weight to the knee.

Cervical Spondylosis

What is the cervical spine?

Cervical spine is the most superior portion of the spinal column and consists of seven vertebrates. It extends from the Cranium to the thoracic vertebra. The cervical spine is the housing structure for our delicate spinal cord responsible for sending messages to the brain. It is sturdy and flexible which allows us to freely move our neck and supports the skull along with its housing units.

Why is the cervical spine important?

The cervical spine performs several important functions which includes:

  1. Protecting the spinal cord

The spinal cord is a bundle of nerves that extends from the brain through the spinal column, the upper part of which is the cervical spine. The spinal column ends at the lumbar spine. Each vertebra is shaped like a disc through which the cord passes. The bony discs protect the spine.

  1. Supporting the cranium and helping the head move

Our head weighs anywhere between 4.5 kg to 5.8 kg which makes the workload of the cervical spine quite heavy. In addition to this, it also enables the flexible movement of the neck and allows a range of motion it has.

  1. Blood flow to the brain

The cervical spine facilitates the blood flow to the brain. The small holes in it provide a passage for the spinal arteries that carry the blood to the brain.

Understanding cervical spondylosis

Cervical spondylosis also known as cervical osteoarthritis is a common age-related condition that affects the discs and joints of the cervical spine. It causes deterioration of the discs, vertebrae and ligaments of the neck or cervical spine. The edges of the vertebrae often develop bone spurs known as osteophytes. This growth can cause the interior of the column to get thinner. This condition causes pain and stiffness in the neck. In case of severe degeneration surgery is recommended although it rarely reaches that stage.

Causes of Cervical Spondylosis

  1. Bone spurs

The bone overgrowth in the region to support the spine can sometimes compress the nerves or other delicate areas of the spine, which can cause pain

  1. Age or overuse

Some jobs and hobbies can increase the risk of aggravating cervical spondylosis. Occupations like construction or a few sports like gymnast can lead to a faster wear and tear of the discs and its ligaments. As people get older their bones get weaker, which may develop into spondylosis.

  1.  Injury

Any previous injury due to accidents or falls can accelerate the ageing process of the spinal vertebrae. If untreated, this degeneration increases the risk of cervical spondolysis.

  1. Ligament stiffness

The sturdy cords that connect the vertebrae to each other become stiff over time which can affect our neck movement and make it hurt.

  1. Herniated discs

The cracks that develop over time in the spinal disc can cause a leakage of the protective material. This can press onto the cord or the spinal nerve which causes pain.

Symptoms of Cervical Spondylosis

  1. In most cases, there is pain and stiffness in the neck and sometimes headaches
  2. It may eventually spread to shoulders, arms, hands and the base of the skull. Movement of the neck might make the pain worse
  3. After a long period of inactivity there is a stiffness in the neck
  4. Headaches that start from the base of the skull and eventually move to the upper half of the cranium
  5. Bone spurs and other growths might press onto blood vessels of the brain which can cause dizziness and blackouts
  6. Some uncommon symptoms include loss of bladder control and equilibrium or in some cases vertigo
  7. Sometimes the arms become weak and the overgrowths may press onto the oesophagus causing difficulty in swallowing
  8. Muscle weakness and numbness in arms and legs can also be a major symptom

Risk factors associated with Cervical Spondylosis

  1. Neck injuries
  2. Work related activities that put extra strain on the neck
  3. Genetic factors or family history of the problem
  4. Smoking
  5. Overweight and inactivity for a prolonged period
  6. Keeping your neck in the same position for a long time.

Treating Cervical Spondylosis

  1. Physical therapy

It helps one bring back flexibility and strength in the neck muscles, it makes them stronger and eventually helps you get rid of the pain.

  • Medications

Regularly taking the medicines as prescribed by the doctor will help you with a speedy recovery and decrease the pain.

  • A cold pack

It will help with pain and decrease the swelling.

  • Resting

Avoiding the activities that put your neck under stress and using a neck brace can help speed up the process.

  • Surgery

Although the physical therapy and medication is almost always sufficient, in cases of severe overgrowth, surgery might be necessary.

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