Test Overview

Arthroscopy is a surgical procedure that lets a doctor look inside your joints. The doctor uses a thin viewing tool called an arthroscope, or scope. It allows the doctor to see the joint surfaces and the tough tissue that covers and cushions the ends of the bones (cartilage). The doctor can also see the surrounding soft tissues, such as tissue that connects bone to bone (ligaments).

This procedure can be used to see if you have a
joint problem or to do surgery that repairs a joint problem. It can also be done to remove a loose or
foreign object in a joint. Doctors can also do it to keep track of a disease or to see how well a treatment is working.
Arthroscopy is most often done on the knee, shoulder, and ankle. It also can
be done on the hip, elbow, and wrist.

During arthroscopy, the
arthroscope is put into your joint through a small cut (incision) in the
skin. The scope has a light source and a video camera attached to it.
Images from the camera can be seen on a video screen. These magnified images
provide a clear picture of your joint. During the procedure, a sample of joint tissue can be
collected to be tested. This is called a biopsy. If needed, more
tools will be put into your joint through other small
incisions.

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 usually:

  • Is less painful.
  • Costs less.
  • Lets you recover sooner, depending on
    what is done.
  • Can be done on an outpatient basis without the need for
    an overnight stay in a hospital. An inpatient stay is often needed with open surgery.

Why It Is Done

Arthroscopy is
used to:

  • Evaluate and diagnose a joint problem when a
    physical exam and other tests don’t give a clear result. These tests may include
    X-rays, blood tests,
    CT scans, or
    magnetic resonance imaging (MRI).
  • Do surgery to repair a joint problem.

It may be used during surgery to:

  • Shave bone tissue to remove calcium
    deposits or bone spurs.
  • Repair or trim soft tissues, such as ligaments, tendons,
    or cartilage.
  • Cut ligaments to help relieve tightness in a stiff joint. They can also be
    repaired or rebuilt.
  • Collect a sample of
    joint tissue or joint fluid (synovial fluid) for testing (biopsy).
  • Remove scar tissue or an area of joint lining
    (synovium) that is swollen.

Some joint problems may be repaired using arthroscopy with open surgery.

How To Prepare

Arthroscopy is often done on an
outpatient basis without the need for an overnight stay in a hospital.

Tell your doctor if you:

  • Are allergic to any medicines, including
    anesthetics.
  • Are taking any medicines, including aspirin or some other blood thinner.
  • 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 last 10
    days. The contrast material may cause swelling within your joint that makes
    doing arthroscopy hard. This swelling can also prevent a clear
    picture of your joint during the procedure.
  • 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.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

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
using crutches after the procedure. If you have arthroscopy of a
joint in your arm, you will likely wear a sling or splint afterward.

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.

During the procedure

If
general or regional anesthesia is used, an
anesthesia specialist will give the medicine.
A general anesthetic will make you sleep during the procedure. Your heart
rate and rhythm, blood pressure, and breathing will be watched closely 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. You will be relaxed and drowsy but will be awake.

You probably will lie on your back. Depending on which joint is being looked
at, an inflatable band (tourniquet) may be used to briefly restrict blood
flow to your joint. This allows your doctor to see all the parts inside your joint.
Your joint is scrubbed with an antiseptic solution and draped with sterile
towels. Before the tourniquet is inflated, the joint will be raised. It may also 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 the doctor inserts the arthroscope, an irrigation fluid
(usually saline) will be used to flush the joint space. This gives the doctor a better view
of the entire joint. A steady low flow of fluid is usually used during the
procedure. This clears out any debris or blood in the joint so your doctor can
evaluate your joint.

After the scope is put in, your doctor
will be able to see inside the joint by viewing a video screen attached to the scope. Your doctor or the surgical assistants may bend, extend, and change the position of the joint to see it from different angles. Videotapes or photos
of the joint may also be taken.

If more surgery is needed to repair your joint problem, more small incisions will be made. Other thin tools will be put into your joint. When the arthroscope and any
other tools are taken out, any blood and debris will be flushed with
saline and drained. To reduce swelling 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 while you recover from surgery.

How long the procedure takes depends on what is done. It may take
only about 15 minutes, but it could take an hour or longer.

After the procedure

After the
procedure, you may need to rest your joint for several days. You may not be
able to drive for 24 hours. This will depend on which joint was
looked at and what type of anesthetic you had. If your stitches aren’t the type that dissolve over time, they will be removed in 7 to 10 days. You can use ice, elevation, and a
compression bandage to reduce any swelling. And you can take pain relievers to relieve any pain or discomfort. Ask your doctor for advice on
strengthening your joint with exercise and when you can do your normal activities.

How It Feels

If you get a local anesthetic
before the procedure, you will feel a brief burning or stinging
in your skin. As the arthroscope is put into the joint, you will notice a thumping feeling. You may feel slight pulling in the joint area as
your doctor moves joint structures around.

If you get a
general anesthetic, you will be asleep and will not
feel anything. If you get 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 to reduce swelling and pain. You may also need to prop it up on pillows. You will have bandages to cover your incision. Keep them
clean and dry.

After the procedure, you may notice bruises around the incision. This will not last long 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 than if you had a simpler
surgery.

Risks

Problems during arthroscopy are not common.
Sometimes there is joint stiffness or long-lasting joint pain. Bleeding inside
the joint can occur, especially if surgery is done during the
procedure.

There is a small chance of infection, getting 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. This happens if pressure builds
inside a muscle compartment (most commonly in the front of the calf or
forearm). When this occurs, medical treatment is needed right away to release
the pressure.

In very rare cases, death can occur from
problems with general anesthesia.

After the test

Contact your doctor right away
if:

  • Your pain or swelling (or both) continue or
    get worse.
  • Your incision site bleeds more than expected.
  • You
    have redness, swelling, pain, or a feeling of heat in your calf or arm.
    These may be signs of a blood clot in a vein. This condition is 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
lets your doctor look inside your joints. The doctor uses a thin
viewing tool called an arthroscope, or scope. Your doctor can see if
your joint is normal by looking at it through the scope. 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. Your doctor may even
do 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.
  • Signs of joint or cartilage
    damage caused by injury or diseases such as
    arthritis.
  • Infection.

After your doctor has evaluated your joint, you may need more
treatment. This could be medicine, physical therapy, or surgery.

What Affects the Test

You may not be able to have the test, or the results may not be helpful, if:

  • You had an
    X-ray of the joint that used
    contrast material (arthrogram) within the previous 10
    days. The contrast material may cause swelling inside the joint. The swelling can
    prevent a clear picture of the joint during arthroscopy.
  • You have
    arthritis. Joint damage caused by arthritis may make it difficult or impossible
    to do this procedure.
  • You have some other medical condition, 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:
    • You have a skin or wound infection near
      the joint to be looked at. But it may be done to clean out an infected
      joint.
    • You have ankylosis. This is a condition that causes
      stiffness and poor flexibility of a joint. It may be caused by a disease (such
      as
      ankylosing spondylitis), a joint injury, or
      surgery.
    • Joint destruction is severe (for example, with severe
      arthritis).
    • You have a severe bleeding disorder. But arthroscopy
      may be done if clotting factor medicines are used.
  • It may take several weeks for your joint to
    heal. 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 exercises or physical therapy for you to do while you recover. 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,
    CT scans, or
    MRI scans before doing an
    arthroscopy. This is to make sure that any problems that need surgery can be done at the
    same time.

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

ByHealthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP – Emergency Medicine
E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Robert B. Keller, MD – Orthopedics

Current as ofMarch 21, 2017