Arthroscopic ulnar nerve identification during posterior elbow arthroscopy

Elbow arthroscopy has increased in popularity in the past 10 years for both diagnostic and therapeutic purposes. A major limiting factor faced by the elbow arthroscopist is the close proximity of the neurovasculature to the working field, with the risk of iatrogenic injury. Many arthroscopic procedures are less extensive than their open equivalents because of an inability to consistently and safely eliminate the risk of neural and vascular injury. Many open procedures in the posterior compartment of the elbow joint are not routinely performed arthroscopically. The primary reason for this restriction in arthroscopic practice is the locality of the posteromedially positioned ulnar nerve in the posterior compartment. Experience and practice with elbow arthroscopic techniques allows surgeons to expand the indications for arthroscopic treatment of an increasing number of elbow pathologies. A philosophy that is routine in open surgery when dealing with pathology that is adjacent to neurovasculature is to identify the neurovasculature and hence reduce the risk of injury. Our aim is to translate this philosophy to arthroscopy by helping define a safe technique for identifying the ulnar nerve in the posteromedial elbow gutter and allowing for a safer performance of procedures in the posteromedial region of the elbow.