Neuroanatomy in elbow arthroscopy

An injury to the median nerve from within the joint during an arthroscopic synovectomy prompted a study of the relationship of the nerves to the capsule and bones of the elbow. Six pairs of cadaveric elbows frozen in 90 degrees of flexion and one pair frozen in extension were sectioned at 5-mm intervals, and the distances from the major nerves to the bones and capsule were recorded. One elbow joint in each pair was filled with saline solution. Saline solution insufflation increased the nerve-to-bone distance with the elbow in flexion. The results were 12 mm for the median nerve and 6 mm for the radial nerve. The capsule-to-nerve distance was affected little by insufflation and was as narrow as 6 mm in three specimens. Extension eliminated the protective effects of insufflation and brought the nerves closer to the bone. These findings confirm (1) the importance of flexion and insufflation in portal placement, (2) that insufflation does not improve the capsule-to-nerve distance, and (3) the potential for "from within-out" injury in synovial procedures.