Posterior Interosseous Nerve Laceration Following Elbow Arthroscopy

Mercer, Deana; Baldwin, Evan D.; Moneim, Moheb S.

doi:10.1016/j.jhsa.2014.05.036

Cited by 12 publications

(5 citation statements)

References 10 publications

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“…Indeed, the radial nerve has been injured during placement of the anterolateral portal. 5,7,10,12 Mercer et al 17 reported an injury to the radial nerve distal to the extensor carpi radialis longus branch during elbow arthroscopy for loose body removal. They attributed the cause to portal placement.…”

Section: Discussionmentioning

confidence: 99%

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The Needle-and-Knife Technique: A Safe Technique for Anterolateral Portal Placement in Elbow Arthroscopy

Thaveepunsan

Shields

O’Driscoll

2019

Orthopaedic Journal of Sports Medicine

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Background:Safe and effective portal placement is crucial for successful elbow arthroscopy. Various techniques for anterolateral portal placement in elbow arthroscopy have been described, yet radial nerve injuries are commonly reported.Purpose:To report on the technique and safety of anterolateral portal placement by the needle-and-knife method and its clinical applications.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review was completed of patients who underwent an arthroscopic procedure in the anterior compartment of the elbow and anterolateral portal placement. Patients were evaluated immediately postoperatively and at subsequent visits and were monitored for signs of radial nerve injury.Results:A total of 460 patients met the inclusion criteria, of which 309 (67%) underwent the needle-and-knife technique. There was 1 case (0.3%) of temporary radial nerve palsy. For the remaining 151 patients who underwent anterolateral portal placement by other techniques, there were 2 cases of temporary radial nerve palsy (1.3%). There were no cases of the needle-and-knife technique being unsuccessful or abandoned in lieu of a different technique. Use of the needle-and-knife technique increased over time with experience and practice. Initially, contraindications to this technique included impaired view of the lateral side of the anterior compartment of the elbow caused by severe intra-articular scar (65%), extensive synovitis (10%), or large osteophytes or loose bodies (10%). For the remaining patients (15%) who did not have portals placed via the needle-and-knife technique, alternate techniques were used for teaching purposes.Conclusion:The needle-and-knife technique is reproducible and easy to perform by a clinician instructed in its use and trained in elbow arthroscopy. Its main advantage is that it permits the surgeon to safely slide the knife along the lateral supracondylar ridge, releasing the scarred capsule and thereby increasing the available space in which to work. Enlarging the working space inside scarred and contracted elbows cannot be accomplished by distending the capsule.

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Section: Discussionmentioning

confidence: 99%

“…2,3,19,22 Elbow arthroscopy is technically challenging and has a degree of risk for nerve injury. 13,17,18,21,25 Safe and effective portal placement is crucial for successful elbow arthroscopy. Sometimes, particularly in elbows with significant scarring and contracture, entry into the joint can be difficult and portal placement challenging.…”

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confidence: 99%

The Needle-and-Knife Technique: A Safe Technique for Anterolateral Portal Placement in Elbow Arthroscopy

Thaveepunsan

Shields

O’Driscoll

2019

Orthopaedic Journal of Sports Medicine

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“…Anteromedial, anterolateral Complete permanent posterior interosseous nerve palsy (transected) Anterolateral Dumonski et al 9 Severe permanent UN palsy (transected) Proximal medial Sodha et al 10 HO development impeding ROM, required open excision Posterior and posterolateral Park et al 11 Transient radial nerve palsy Proximal anterolateral Gay et al 12 Complete permanent UN palsy (transected) Proximal anteromedial Hughes and Hildebrand 13 HO development impeding ROM, required open incision Dexel et al 14 Transient aseptic subcutaneous emphysema Carafino et al 15 Complete permanent posterior interosseous nerve (PIN) Proximal anterolateral Carafino et al 15 Partial medial nerve (sensory) injury Proximal anteromedial Murphy et al 16 Severe permanent median nerve (MN) palsy (transected) Kinkartz et al 17 Postarthroscopic chondrolysis Mercer et al 18 Radial nerve (RN) palsy (laceration) Proximal anterolateral Desai et al 19 HO Excessive traction, cross-body adduction, lateral positioning and repetitive tourniquet inflation/ deflation should be avoided; management of modifiable risk factors (smoking cessation, diabetes, obesity, HTN); consider chemical prophylaxis in higher risk patients tourniquet time are not uncommon in this setting. 33 Thus, time of tourniquet inflation must be monitored similar to other procedures.…”

Section: References Complications Portalmentioning

confidence: 99%

Complications in Elbow Arthroscopy: Management and Prevention

Batko

Hakakian

Norin

et al. 2022

Sports Medicine and Arthroscopy Review

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With advances in the understanding of elbow anatomy, pathologies of the elbow, arthroscopic instrumentation, and surgical techniques over recent decades, elbow arthroscopy has become a valuable treatment modality for a variety of conditions. Elbow arthroscopy has gained utility for treating problems such as septic arthritis, osteoarthritis, synovitis, osteophyte and loose body excision, contracture release, osteochondral defects, select fractures, instability, and lateral epicondylitis. Accordingly, precise knowledge of the neurovascular anatomy, safe arthroscopic portal placement, indications, and potential complications are required to maximize patient outcomes and assist in educating patients. This comprehensive review provides the reader an understanding of the potential complications associated with arthroscopic procedures of the elbow and to describe strategies for prevention and management.

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“…It may have dramatic consequences on forearm function and hence negatively affect the surgical outcome of procedures to the anterior and lateral aspect of the elbow. 1 2 3 4 5 6 7 …”

Section: Introductionmentioning

confidence: 99%

Distance of the Posterior Interosseous Nerve from the Radial Head during Elbow Arthroscopy: An Anatomical Study

Arrigoni

Cucchi

Guerra

et al. 2017

Joints

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Purpose The aims of this study were to measure the distance of the posterior interosseous nerve (PIN) from the radial head (RH) and its variations with forearm movements. Methods Five fresh frozen cadaver specimens were dissected under arthroscopy. An anterior capsulectomy extended to the entire lateral compartment was performed. The need of soft tissue dissection to isolate the nerve in the extracapsular space was recorded. The distance between the nerve and the anterior part of the RH was then measured with a graduated caliper inserted via the midlateral portal with the forearm in neutral position, full pronation, and full supination. Results The PIN was identifiable in all the specimens. In four cases, it was surrounded by a thick layer of adipose tissue, and further dissection was necessary to isolate it. Damage of the PIN during dissection occurred in one case, in which the proximal part of the nerve was accidentally cut. In three of the remaining cases, an increased distance was measured with the forearm in supination, as compared with neutral and full pronation position. Conclusion This anatomical study suggests that in most of the cases, the PIN does not lay just extracapular at the level of the radiocapitellar joint, but is surrounded by a thick layer of adipose tissue. Furthermore, its distance from the RH appears to increase with forearm supination. This position could increase the safe working space between RH and PIN. Clinical Relevance Knowledge of PIN position in relation to the anterior elbow capsule and its changes with forearm movements can help reduce the iatrogenic injuries during elbow arthroscopy.

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Posterior Interosseous Nerve Laceration Following Elbow Arthroscopy

Cited by 12 publications

References 10 publications

The Needle-and-Knife Technique: A Safe Technique for Anterolateral Portal Placement in Elbow Arthroscopy

The Needle-and-Knife Technique: A Safe Technique for Anterolateral Portal Placement in Elbow Arthroscopy

Complications in Elbow Arthroscopy: Management and Prevention

Distance of the Posterior Interosseous Nerve from the Radial Head during Elbow Arthroscopy: An Anatomical Study

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