Endoscopic extracapsular capsulectomy of the elbow: a neurovascularly safe technique for high-grade contractures

Arthroscopic management of elbow contractures is rapidly becoming the primary operative form of treatment for many physicians. Safety concerns remain the primary limiting factor in its more widespread use. We use an extra-articular starting point in extremely difficult fixed contractures, and this technique is documented in this report. The ulnar nerve is initially identified and protected with a palpating finger, while a periosteal elevator is introduced through a proximal medial skin portal. A channel between the anterior humeral cortex and anterior musculature is created, and an arthroscope is introduced through a proximal lateral portal at the lateral aspect of the channel. The anterior capsule is dissected from the musculature/neurovasculature under direct vision and safely excised once the medial and lateral margins are safely identified. A useful technical tip is that retractors can be placed in auxiliary portals to deflect the muscles and fat pad to improve the ability to perform dissection under direct vision.