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Neuroanatomy in elbow arthroscopy

C D Miller¹, C M Jobe, M H Wright

¹Department of Orthopaedic Surgery, Loma Linda University School of Medicine, CA 92350, USA.

Journal of Shoulder and Elbow Surgery

|May 1, 1995

Summary

Arthroscopic elbow surgery requires careful nerve protection. Flexion and saline insufflation increase median and radial nerve distance from bone, but not from the capsule, highlighting risks during synovectomy.

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Area of Science:

Orthopedic Surgery
Anatomy
Surgical Safety

Background:

Arthroscopic elbow procedures, such as synovectomy, carry a risk of iatrogenic nerve injury.
Understanding the spatial relationship between nerves and intra-articular structures is crucial for safe portal placement.

Observation:

Cadaveric elbow specimens were dissected to measure distances between major nerves (median, radial) and the joint capsule/bones.
Measurements were taken with the elbow in flexion and extension, with and without saline insufflation.

Findings:

Saline insufflation significantly increased the distance between the median nerve and bone (12 mm) and the radial nerve and bone (6 mm) in flexion.
Insufflation had minimal effect on the capsule-to-nerve distance, which remained as little as 6 mm in some specimens.
Elbow extension reduced the protective effect of insufflation, bringing nerves closer to the bone.

Implications:

Flexion and saline insufflation are vital considerations for safe portal placement in arthroscopic elbow surgery.
Surgeons must recognize that insufflation does not guarantee increased safety margins to the joint capsule.
These findings underscore the potential for "from within-out" nerve injuries during synovial procedures, emphasizing the need for meticulous technique.

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