Neurovascular anatomy and elbow arthroscopy: Inherent risks

Lynch, Garrett J.; Meyers, John F.; Whipple, Terry L.; Caspari, Richard B.

doi:10.1016/s0749-8063(86)80067-6

Cited by 196 publications

(129 citation statements)

References 3 publications

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“…Specimens in our study did not have arthrofibrosis, which might limit the applicability of our data in this patient group. Moreover, our study did not evaluate the capsule-to-nerve distance, which has been analyzed in previous studies [17,19]. Although meticulously performed and kept to a minimum, specimen dissection could also bias the obtained results.…”

Section: Discussionmentioning

confidence: 96%

“…Nevertheless, nerve injuries have been reported in 2.2% of cases as a result of the close proximity of major nerves to the joint [23], which is why many anatomic studies focused on the location of these nerves-mostly with regard to arthroscopic portal placement [2,6,7,21,31,33]. The median and radial nerves are in particular jeopardy during anterior capsulectomy, yet their location in relation to osseous landmarks has been described only through macroscopic measurements prone to inaccuracy [17,19,21]. Thus far, precise information on the influence of joint flexion and insufflation to increase the bone-to-nerve distance at the anterior aspect of the elbow is lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the risk of neurological complications during arthroscopic arthrolysis of the elbow may be reduced. Previous studies have investigated the influence of elbow flexion and joint distension only by means of gross anatomic dissection [17,19]. Therefore, comparable results before and after insufflation could only be obtained by use of matched pairs [19].…”

Section: Discussionmentioning

confidence: 99%

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Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations

Hackl

Lappen

Burkhart

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The median and radial nerves are at risk of iatrogenic injury when performing arthroscopic arthrolysis with anterior capsulectomy. Although prior anatomic studies have identified the position of these nerves, little is known about how elbow positioning and joint insufflation might influence nerve locations. Questions/purposes In a cadaver model, we sought to determine whether (1) the locations of the median and radial nerves change with variation of elbow positioning; and whether (2) flexion and joint insufflation increase the distance of the median and radial nerves to osseous landmarks after correcting for differences in size of the cadaveric specimens. Methods The median and radial nerves were marked with a radiopaque thread in 11 fresh-frozen elbow specimens. Three-dimensional radiographic scans were performed in extension, in 90°flexion, and after joint insufflations in neutral rotation, pronation, and supination. Trochlear and capitellar widths were analyzed. The distances of the median nerve to the medial and anterior edge of the trochlea and to the coronoid were measured. The distances of the radial nerve to the lateral and anterior edge of the capitulum and to the anterior edge of the radial head were measured. We analyzed the mediolateral nerve locations as a percentage function of the trochlear and capitellar widths to control for differences regarding the size of the specimens. Results The mean distance of the radial nerve to the lateral edge of the capitulum as a percentage function of the capitellar width increased from 68% ± 17% in extension to 91% ± 23% in flexion (mean difference = 23%; 95% confidence interval [CI], 5%-41%; p = 0.01). With the numbers available, no such difference was observed Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Department of Anatomy, University of Cologne, Cologne, Germany. regarding the location of the median nerve in relation to the medial border of the trochlea (mean difference = 5%; 95% CI, À13% to 22%; p = 0.309). Flexion and joint insufflation increased the distance of the nerv...

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations

Hackl

Lappen

Burkhart

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…[10][11][12] The surgeon places the anteriorlateral portal first. The radial nerve, posterior antebrachial cutaneous nerve, and posterior interosseous nerve are all in danger with the anterior-lateral portal.…”

Section: Discussionmentioning

confidence: 99%

“…Stothers et al 11 showed that this portal has improved visualization and is safer than more distal portals. Lynch et al 12 showed that the posterior antebrachial cutaneous nerve is an average of 2 mm from the sheath. The anterior-medial portal, if used, possesses its own neurovascular risk and is placed under direct visualization.…”

Section: Discussionmentioning

confidence: 99%

Valgus Extension Overload: Arthroscopic Decompression in the Supine-Suspended Position

Barousse

Saper

Meijer

et al. 2016

Arthroscopy Techniques

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Elbow arthroscopy is a useful tool for managing diseases of the elbow, including valgus extension overload, when conservative treatments have failed. Arthroscopic access to the elbow in the supine-suspended position is simple and reproducible with the technique described in this report. Synovial tissue can be cleared, optimizing visualization of the anatomic structures in the elbow including the posterior ulnohumeral joint. This report describes, in detail, arthroscopy of the elbow in the supine-suspended position and basic principles for arthroscopic decompression of the posterior elbow for valgus extension overload.

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Evaluation of loose bodies in the elbow with MR imaging

Quinn

Haberman

Fitzgerald

et al. 1994

Magnetic Resonance Imaging

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The evaluation of loose bodies in the elbow is usually done by means of clinical examination, radiography, and postarthrographic computed tomography (CT). The authors review their experience with magnetic resonance (MR) imaging in place of post-arthrographic CT for the evaluation of loose bodies in the elbow. The prospective interpretation of MR studies of the elbow in 20 patients was compared with arthroscopic findings. All elbows were imaged in multiple planes with thin sections, surface coils, and combinations of T1, T2, and proton-density weighting. The sensitivity for showing loose bodies with MR imaging was 100%, and the specificity was 67%. Because this was a nonblinded study, the results are biased and caution must be used when extrapolating these results to the general population. In this limited experience, MR imaging has reliably shown loose bodies in the elbow, and in the authors' institutions has replaced postarthrographic CT for that purpose.

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Neurovascular anatomy and elbow arthroscopy: Inherent risks

Cited by 196 publications

References 3 publications

Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations

Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations

Valgus Extension Overload: Arthroscopic Decompression in the Supine-Suspended Position

Evaluation of loose bodies in the elbow with MR imaging

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