Ultrasound-Assisted Posteromedial Portal Placement of the Elbow Joint to Prevent Ulnar Nerve Injury

Ohuchi, Hiroshi; Torres, Rolando Junior L.; Shinga, Kotaro; Ichikawa, Kimihisa; Kato, Yuki; Hattori, Satoshi; Yamada, Shin

doi:10.1016/j.eats.2017.03.024

Cited by 5 publications

(4 citation statements)

References 17 publications

(25 reference statements)

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“…Ohuchi et al [ 16 ] presented a technique applicable to portal placement of the elbow using an ultrasound-assisted method. However, they did not perform this technique in a large number of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Powell et al [ 15 ] reported that map planning surgical access would benefit from preoperative sonography of the ulnar nerve. In addition, Ohuchi et al [ 16 ] concluded that ultrasound-assisted posteromedial portal placement of the elbow joint avoids ulnar nerve injuries; however, reports on the use of assistive techniques to establish an anterolateral approach are limited.…”

Section: Introductionmentioning

confidence: 99%

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Application of ultrasound in avoiding radial nerve injury during elbow arthroscopy: a retrospective follow-up study

Wang

et al. 2022

BMC Musculoskelet Disord

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Background A safe and effective technique for anterolateral portal placement in elbow arthroscopy is significant. We compared the outcomes of patients who underwent elbow arthroscopy using different ultrasound-assisted techniques. Methods From May 2016 to June 2021 a retrospective analysis on all patients who underwent elbow arthroscopy in our department was performed. Patients were separated into three groups: non-ultrasound; preoperative ultrasound; and intraoperative ultrasound. The minimum follow-up period was 1 year. Nerve injuries, visual analog scale (VAS), Mayo elbow-performance score (MEPS), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and range of motion (ROM) of the elbow were evaluated for comparison among the three groups pre- and post-operatively. Results All 55 patients completed a 1-year follow-up: non-ultrasound (n = 20); preoperative ultrasound (n = 17); and intraoperative ultrasound (n = 18). There were 3 cases (15.0%) of transient radial nerve palsy in the non-ultrasound group. No nerve complications occurred in preoperative ultrasound and intraoperative ultrasound groups. The probability of postoperative radial nerve injury in the three groups was statistically different (P < 0.05). There was no significant difference in the VAS score, MEPS, DASH score, and ROM among the three groups at the follow-up evaluation (P > 0.05). Conclusion Performing anterolateral portal placement during elbow arthroscopy with ultrasound-assisted techniques successfully avoided radial nerve injury.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Application of ultrasound in avoiding radial nerve injury during elbow arthroscopy: a retrospective follow-up study

Wang

et al. 2022

BMC Musculoskelet Disord

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“…The latter may lead to accidental entanglement or suction injury of the ulnar nerve, as the medial capsule forms only a thin barrier between the arthroscopic working space and the nerve. The posteromedial portal is generally not used, as it directly overlies the ulnar nerve [21, 28].…”

Section: Discussionmentioning

confidence: 99%

Locating the ulnar nerve during elbow arthroscopy using palpation is only accurate proximal to the medial epicondyle

Hilgersom

Cucchi

Luceri

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose Knowledge of ulnar nerve position is of utmost importance to avoid iatrogenic injury in elbow arthroscopy. The aim of this study was to determine how accurate surgeons are in locating the ulnar nerve after fluid extravasation has already occurred, and basing their localization solely on palpation of anatomical landmarks. Methods Seven cadaveric elbows were used and seven experienced surgeons in elbow arthroscopy participated. An arthroscopic setting was simulated and fluids were pumped into the joint from the posterior compartment for 15 min. For each cadaveric elbow, one surgeon was asked to locate the ulnar nerve solely by palpation of the anatomical landmarks, and subsequently pin the ulnar nerve at two positions: within 5 cm proximal and another within 5 cm distal of a line connecting the medial epicondyle and the tip of the olecranon. Subsequently, the elbows were dissected using a standard medial elbow approach and the distances between the pins and ulnar nerve were measured. Results The median distance between the ulnar nerve and the proximal pins was 0 mm (range 0-0 mm), and between the ulnar nerve and the distal pins was 2 mm (range 0-10 mm), showing a statistically significant difference (p = 0.009). All seven proximally placed pins (100%) transfixed the ulnar nerve versus two out of seven distally placed pins (29%) (p = 0.021). Conclusions In a setting simulating an already initiated arthroscopic procedure, the sole palpation of the anatomical landmarks allows experienced elbow surgeons to accurately locate the ulnar nerve only in its course proximal to the medial epicondyle (7/7, 100%), whereas a significantly reduced accuracy is documented when the same surgeons attempt to locate the nerve distal to the medial epicondyle (2/7, 29%; p = 0.021). Current findings support the establishment of a proximal anteromedial portal over a distal anteromedial portal to access the anterior compartment after tissue extravasation has occurred with regard to ulnar nerve safety.

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“…US-guided repair techniques have been reported as the "third generation" procedures for acute Achilles tendon rupture [19], medial collateral ligament [20] and medial patellofemoral ligament tear of the knee [21], and anterior talofibular ligament injury in the ankle [22][23][24]. Some arthroscopic surgeons found it helpful to guide arthroscopic procedures with ultrasound [25][26][27][28].…”

Section: Us-guided Surgery In Msk Medicinementioning

confidence: 99%

Ultrasound-guided surgery in musculoskeletal medicine

Hattori

Onishi

2022

J Med Ultrasonics

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Ultrasound-Assisted Posteromedial Portal Placement of the Elbow Joint to Prevent Ulnar Nerve Injury

Cited by 5 publications

References 17 publications

Application of ultrasound in avoiding radial nerve injury during elbow arthroscopy: a retrospective follow-up study

Application of ultrasound in avoiding radial nerve injury during elbow arthroscopy: a retrospective follow-up study

Locating the ulnar nerve during elbow arthroscopy using palpation is only accurate proximal to the medial epicondyle

Ultrasound-guided surgery in musculoskeletal medicine

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