Elbow Arthroscopy: A New Setup to Avoid Visual Paradox and Improve Triangulation

Sinha, Apurv; Pydah, S K V; Webb, Mark

doi:10.1016/j.eats.2012.11.003

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…Several authors have described various strategies to avoid nerve damage during elbow arthroscopy, these include avoiding suction close to the nerves, keeping the arthroscope and instruments close to bone, limiting tourniquet time to <2 h, avoiding excessive retraction of nerves, change in the set up to avoid visual paradox by keeping the monitor at the head end of the table, and following a safety driven step wise strategy in a standardized sequence. 5 6 17 18 Placing the patient's elbow in 90° of flexion before portal placement and prone position during arthroscopy are also said to be helpful as the gravity assists in displacing the anterior neurovascular structures away from the joint; 7 prone position also offers the benefit of easier conversion to an open procedure, if required, without changing patient position and re draping.…”

Section: Discussionmentioning

confidence: 99%

“… 3 Elbow arthroscopy is a demanding procedure 1 4 5 compared to the more accessible knee and shoulder joints 5 and involves a steep learning curve. 6 7 The indications for elbow arthroscopy are removal of loose bodies, joint contracture release, osteochondritis dissecans, fractures of the capitellum, coronoid process, and radial head in managing elbow trauma, synovectomy, synovial chondromatosis and debridement of osteoarthritic elbow, pain without a diagnosis, instability, lateral epicondylitis, plicae, chronic valgus overload, posteromedial impingement and septic arthritis. 1 2 3 4 5 8 9 10 11 12…”

Section: Introductionmentioning

confidence: 99%

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Risk of nerve injury during arthroscopy portal placement in the elbow joint

Chaware

Santoshi

Pakhare

et al. 2016

IJOO

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Background:Elbow arthroscopy has become a routine procedure now. However, placing portals is fraught with dangers of injuring the neurovascular structures around elbow. There are not enough data documenting the same amongst the Indians. We aimed to determine the relative distances of nerves around the elbow to the arthroscopy portals and risk of injury in different positions of the elbow.Materials and Methods:Six standard elbow arthroscopy portals were established in 12 cadaveric upper limbs after joint distension. Then using standard dissection techniques all the nerves around the elbow were exposed, and their distances from relevant portals were measured using digital vernier caliper in 90° elbow flexion and 0° extension. Descriptive statistical analysis was used for describing distance of the nerves from relevant portal. Wilcoxon-signed rank test and Friedman's test were used for comparison.Results:There was no major nerve injury at all the portals studied in both positions of the elbow. The total incidence of cutaneous nerve injury was 8.3% (12/144); medial cutaneous nerve of forearm 10/48 and posterior cutaneous nerve of forearm 2/24. No significant changes were observed in the distance of a nerve to an individual portal at 90° flexion or 0° extension position of the elbow.Conclusion:This study demonstrates the risk of injury to different nerves at the standard portals of elbow arthroscopy. In practice, the actual incidence of nerve injury may still be lower. We conclude that elbow arthroscopy is a safe procedure when all precautions as described are duly followed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk of nerve injury during arthroscopy portal placement in the elbow joint

Chaware

Santoshi

Pakhare

et al. 2016

IJOO

View full text Add to dashboard Cite

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A Novel Method of Patient Positioning Using Shoulder Arthroscopy Equipment for Elbow Arthroscopy

Kowalski¹,

Monica²

2018

Orthopedics

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Indications for elbow arthroscopy are expanding; however, it is uncommon compared with shoulder arthroscopy. Elbow arthroscopy can be complicated by positioning, including the need to obtain specific arm holders required by most operating rooms. Surgery can be performed in the supine, prone, or lateral position. Arm traction allows for distraction of the joint space, full insufflation, and therefore visualization of intra-articular anatomy. This article outlines a new technique using previously available shoulder arthroscopy equipment to avoid increased cost incurred by procuring new, elbow-specific equipment. This technique is performed in the supine position using a hydraulic system and a shoulder 3-point distractor. [Orthopedics. 2018; 41(1):e158-e160.].

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Elbow Arthroscopy: A New Setup to Avoid Visual Paradox and Improve Triangulation

Cited by 2 publications

References 8 publications

Risk of nerve injury during arthroscopy portal placement in the elbow joint

Risk of nerve injury during arthroscopy portal placement in the elbow joint

A Novel Method of Patient Positioning Using Shoulder Arthroscopy Equipment for Elbow Arthroscopy

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