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Avoiding nerve damage during elbow arthroscopy

P D Marshall1, J A Fairclough, S R Johnson

  • 1Cardiff Royal Infirmary, Wales, UK.

The Journal of Bone and Joint Surgery. British Volume
|January 1, 1993
PubMed
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Elbow arthroscopy requires careful portal placement to avoid nerve injury. The posterior interosseous nerve is near the anterolateral portal, and the median nerve is close to the anteromedial portal.

Area of Science:

  • Orthopedic Surgery
  • Anatomy
  • Minimally Invasive Procedures

Background:

  • Elbow arthroscopy is a common procedure for diagnosing and treating various elbow conditions.
  • Understanding the precise anatomical relationships between nerves and arthroscopic portals is crucial for surgical safety.
  • Previous studies have highlighted potential risks to nerves during elbow arthroscopy, necessitating further investigation.

Purpose of the Study:

  • To delineate the exact anatomical proximity of critical nerves to frequently utilized elbow arthroscopy portals.
  • To identify specific portals associated with a higher risk of iatrogenic nerve injury during elbow arthroscopy.
  • To provide anatomical guidance for safe portal selection in elbow arthroscopic procedures.

Main Methods:

  • Twenty adult cadaveric elbows were utilized for the study.

Related Experiment Videos

  • An arthroscope was introduced through standard elbow arthroscopy portals in each specimen.
  • Detailed dissection was performed to identify and map the course of the ulnar, median, and radial nerves relative to the portals.

    • Main Results:

    • The posterior interosseous nerve was consistently found in close proximity to the radiohumeral joint and the anterolateral portal.
    • Forearm pronation was observed to displace the posterior interosseous nerve away from the arthroscope.
    • The median nerve was located within 14 mm of the arthroscope when introduced via the anteromedial portal, placing superficial forearm flexor muscle branches at risk.

    Conclusions:

    • The anterolateral portal in elbow arthroscopy poses a risk to the posterior interosseous nerve.
    • The anteromedial portal presents a risk to the median nerve and its branches supplying the superficial forearm flexors.
    • Surgeons must exercise caution and consider nerve proximity when selecting portals for elbow arthroscopy to prevent iatrogenic injury.