Avoiding nerve damage during elbow arthroscopy

Abstract

To define the anatomical relationships of the nerves to the common arthroscopy portals at the elbow an arthroscope was introduced into 20 cadaver elbows and the positions of the nerves were then determined by dissection. In all cases the posterior interosseous nerve lay close to the radiohumeral joint and to the anterolateral portal. Pronation of the forearm displaced the nerve away from the arthroscope. The median nerve passed consistently within 14 mm of the arthroscope when it was introduced through the anteromedial portal. The branches supplying the superficial forearm flexor muscles were at risk.

Anatomic relationship between elbow arthroscopy portals and neurovascular structures in different elbow and forearm positions

“…The mean distance between the radial nerve and the anterolateral portal was measured as 9.1 mm at 90°of flexion and 4.7 mm during extension. On the other hand, Marshall et al 11 reported that pronation of the forearm resulted in an increase in the distance of the radial nerve from the portal route.…”

Arthroscopic arthrolysis for posttraumatic elbow stiffness

“…Arthroscopic release is challenging because the neurovascular structures are close to the portals and the restricted working space afforded to the congruity of the joint and noncompliant capsule. 6,17,19,27 Early reports of arthroscopic elbow capsule release documented nerve injuries, but the safety profile has improved safety over time. (7 ) in the open group.…”

Basics of Elbow Arthroscopy Part I: Surface Anatomy, Portals, and Structures at Risk

“…The mean distance of the DALP to the radial nerve has been reported from 4.0 to 7.2 mm. [7][8][9][10]12 The posterior antebrachial cutaneous nerve is approximately 7.6 to 12.6 mm away. 8,10 To avoid this risk of injury, many surgeons advocate moving this portal more proximal.…”

“…Given its transtendinous location, it is relatively safe from surrounding neurovascular structures. 7,8,10 Posterolateral Portal. The posterolateral portal is located along the lateral border of the triceps tendon approximately 1 cm anterior to the midpoint of a line connecting the olecranon and the LE.…”