Sensory innervation of the human elbow joint and surgical considerations

Abstract

Based on the currently available literature, total denervation of the elbow joint is considered impossible. However, consensus with respect to the anatomic location of sensory branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the elbow joint, as well as the distribution of sensory receptors about its capsule. Four electronic databases were queried, between January 1945 and June 2019. Twenty‐one original articles providing a detailed description of the distribution of sensory receptors about the elbow joint capsule (5) and its articular branches (16) were reviewed. The posterior capsule was found to be primarily innervated by the ulnar and radial nerves via combined articular branches and sensory branches of the medial antebrachial cutaneous nerve. The anterior capsule was found to be primarily innervated by a plexus of articular ramifications from muscular branches of mixed nerves (ulnar, musculocutaneous, radial, and median nerves). A higher density of nociceptors and mechano‐receptors was identified within the posterior and anterior capsules, respectively. Thorough denervation, via the technique proposed herein, is likely to be sufficient in eliminating pain from degenerative conditions of the elbow joint.

Peri-humeral block for postoperative analgesia in patients with distal humerus surgery

“…With major peripheral nerves (radial, ulnar, and median) around the elbow, surgeon often demands preservation of distal motor function in the immediate postoperative period for neurological assessment. [ 6 ] Thus, it would be justified to administer a highly specific block targeting the articular and cutaneous nerves to the distal humerus (proximal elbow joint) in the form of a PHB.…”

Prevalence, Timing, Locational Distribution, and Risk Factors for Heterotopic Ossification After Elbow Arthroscopy

“…16 The capsules showed abundant nerves, 20,21,28 and arthroscopic osteocapsular debridement reportedly damaged many mechanoreceptors. 22,28 This may explain the highest prevalence of HO in patients with posttraumatic stiffness, as more aggressive osteocapsular arthroplasty is performed to recover functional range of motion during surgery.…”

“…Mechanical injury of peripheral nerves triggered HO, possibly because of injury to axons and their myelin sheath after the nerves were transected and neuroinflammation was provoked by the injury. 16 The capsules showed abundant nerves, 20,21,28 and arthroscopic osteocapsular debridement reportedly damaged many mechanoreceptors. 22,28 This may explain the highest prevalence of HO in patients with posttraumatic stiffness, as more aggressive osteocapsular arthroplasty is performed to recover functional range of motion during surgery.…”

Bloqueio anestésico em epicondilite lateral, qual a inervação sensitiva? relato de casos

“…Em uma revisão sistemática foram incluídos e avaliados 21 artigos sobre a inervação sensitiva do cotovelo. 4 Identificaram, em sua maioria, um ramo sensitivo para a cápsula articular, originado do nervo cutâneo posterior do antebraço (PCNF) que inerva o epicôndilo lateral após atravessar o músculo braquiorradial, sendo essa a anatomia compatível com os três cotovelos em que foram realizados os procedimentos. 4 Outros ramos também foram identificados, porém nem todos os artigos chegaram à mesma conclusão, existindo, dessa maneira, a necessidade de aprimorar o conhecimento sobre a inervação sensitiva do cotovelo.…”

“…Quando a escolha é a realização de um bloqueio anestésico, sabemos que falta um consenso quanto à localização anatômica dos ramos sensoriais. 4 Objetivo Dessa forma, o objetivo deste relato de casos é descrever duas pacientes que responderam com melhora da dor após o bloqueio realizado com anestésico na região do epicôndilo lateral e ressignificar a maneira como são feitos os procedimentos minimamente invasivos, evitando dor e sofrimento nos pacientes.…”