The incidence of neurologic complications and associated risk factors in elbow surgery: an analysis of 2759 cases

Rheenen, Thijs A. van; Bekerom, Michel P.J. van den; Eygendaal, Denise

doi:10.1016/j.jse.2015.07.033

Cited by 10 publications

(5 citation statements)

References 26 publications

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“…van Rheenen et al recently reviewed 2,759 surgical operations on the elbow comprising both arthroscopic and open procedures and found neurological deficit in only ten patients 35. They concluded that an awareness of anatomical landmarks, identification and marking of the ulnar nerve, and exposing nerves during open surgery were the main contributors to avoiding neurological complications in this series.…”

Section: Surgical Approaches For Termentioning

confidence: 74%

<p>Total elbow replacement – patient selection and perspectives</p>

Pooley¹

2019

ORR

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Total joint replacements for elbow arthritis were developed in the late 1960s at the same time as total joint replacements for knee joint arthritis. Since then, there has been a continuing annual increase in the number of patients treated with total knee joint replacement for arthritis, in line with replacement arthroplasty of the other major limb joints, but in contrast to total elbow joint replacement which is falling, since reaching a peak in the 1990s. Which raises the question, why? Continuing controversy about implant design, the relatively high reported complication rates associated with total elbow replacement (TER) and the difficulties encountered in revision surgery are identified as reasons together with changes in the patient population currently treated with TER. The purpose of this review is to explore the reasons for this in the context of the patient population requiring implant surgery for elbow arthritis and our current perspective of elbow pathology requiring treatment. This is not a systematic review of the whole of the literature concerning total elbow joint replacement arthroplasty but is drawn largely from the supporting literature that reflects my own clinical experience and illustrated with teaching materials I have commissioned together with radiographs and intraoperative photographs of patients I have treated.

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Section: Surgical Approaches For Termentioning

confidence: 74%

<p>Total elbow replacement – patient selection and perspectives</p>

Pooley¹

2019

ORR

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“…Elbow arthroscopy performed for the treatment of osteoarthritis, inflammatory arthritis and loose body removal has about a 0.8 % rate of joint infection [ 34 ]. Furthermore, a recent retrospective review of 1004 elbow arthroscopy procedures identified a transient neurologic deficit in 4 patients (2 ulnar, 1 radial nerve palsies), all of whom had complete resolution of symptoms by 6 weeks postoperative, and one permanent ulnar nerve palsy secondary to direct injury to the nerve (discovered on subsequent exploratory surgery) [ 35 ]. Conversely, arthroscopic surgery specifically for tennis elbow has an extremely low risk of complications.…”

Section: Discussionmentioning

confidence: 99%

A randomized, double-blind sham-controlled trial on the efficacy of arthroscopic tennis elbow release for the management of chronic lateral epicondylitis

Matache

Berdusco

Momoli

et al. 2016

BMC Musculoskelet Disord

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BackgroundTennis elbow is a common elbow pathology typically affecting middle-aged individuals that can lead to significant disability. Most cases resolve within 2 years of symptom onset, but a subset of patients will develop persistent symptoms despite appropriate conservative management. There are several surgical approaches used to treat chronic tennis elbow, with arthroscopic surgery becoming an increasingly popular approach to address this pathology in North America. This procedure involves the arthroscopic release of the extensor carpi radialis brevis tendon (ECRB) origin at the elbow. The potential benefit of arthroscopic treatment of this condition is improved patient outcomes and shorter recovery time following surgery. The results of this technique have been reported only in the context of case series, which have shown positive results. However, in order to justify its widespread use and growing popularity, a high level of evidence study is required. The purpose of this prospective, randomized sham-controlled trial is to determine whether arthroscopic tennis elbow release is effective at treating chronic lateral epicondylitis.MethodsWe will conduct a prospective single center, double-blind, randomized sham-controlled parallel arm trial evaluating the efficacy of arthroscopic tennis elbow release in adult patients with symptoms for at least 6 months. Patients will undergo intraoperative randomization after diagnostic arthroscopy of the elbow to receive either ECRB release (through the creation of a lateral portal) or a sham lateral portal and no ECRB release. The primary outcome will be the Mayo Elbow Performance Score (MEPS) at 1 year follow-up. Secondary outcomes will be the abbreviated Disability of the Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons elbow (ASES-e) score and grip strength at 3, 6, 12 and 24 months as well as return-to-work time, ability to return to full duty and adverse outcomes.DiscussionResults of this study will provide empirical high quality evidence to guide clinical decision-making in patients with chronic tennis elbow.Trial registrationNCT02236689 (September 8, 2014)

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“…As such, the most commonly encountered neurovascular structure is the ulnar nerve. 20,21 Although disarticulation at the time of surgery can certainly place the more anteriorly based structures at risk, it is the ulnar nerve that resides in the posterior portion of the elbow joint (Figure 1).…”

mentioning

confidence: 99%

“…It is important to have a thorough understanding of the three dimensional anatomy of the elbow and these surrounding structures to decrease the chance of inadvertent injury. 20 Various natural planes or muscle splitting approaches can afford a 360-degree approach to the elbow depending on the pathology being addressed at the time of surgery. In the case of TEA, nearly all used approaches begin with a posterior skin incision.…”

mentioning

confidence: 99%

Surgical Exposures for Total Elbow Arthroplasty

Horneff

Ramsey

2019

J Am Acad Orthop Surg

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Indications for total elbow arthroplasty (TEA) were traditionally reserved for patients with advanced rheumatoid disease and posttraumatic conditions of the elbow. The indications have expanded for TEA to include patients with acute elbow trauma, dysfunctional instability, and end-stage osteoarthritis. Many of these patients are younger and place a greater demand on their TEA. This evolution of TEA use combined with the concern of soft tissue handling and triceps function has led to increased interest regarding surgical exposure for TEA. Three generalized approaches to TEA are predicated on the handling of the triceps tendon: triceps reflecting, triceps splitting, and triceps sparing. Each of these approaches has its own inherent advantages and disadvantages. As indications grow for TEA and the possibility of revision surgery increases with use in younger, higher demand patients, it is important for treating surgeons to use these various exposures so that they are capable of treating patients in a variety of settings.

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The incidence of neurologic complications and associated risk factors in elbow surgery: an analysis of 2759 cases

Cited by 10 publications

References 26 publications

<p>Total elbow replacement – patient selection and perspectives</p>

<p>Total elbow replacement – patient selection and perspectives</p>

A randomized, double-blind sham-controlled trial on the efficacy of arthroscopic tennis elbow release for the management of chronic lateral epicondylitis

Surgical Exposures for Total Elbow Arthroplasty

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The incidence of neurologic complications and associated risk factors in elbow surgery: an analysis of 2759 cases

Cited by 10 publications

References 26 publications

<p>Total elbow replacement &ndash; patient selection and perspectives</p>

<p>Total elbow replacement &ndash; patient selection and perspectives</p>

A randomized, double-blind sham-controlled trial on the efficacy of arthroscopic tennis elbow release for the management of chronic lateral epicondylitis

Surgical Exposures for Total Elbow Arthroplasty

Contact Info

Product

Resources

About

<p>Total elbow replacement – patient selection and perspectives</p>

<p>Total elbow replacement – patient selection and perspectives</p>