Abstract
Background: Elbow arthroscopy has become a routine procedure now. However, placing portals is fraught with dangers of injuring the neurovascular structures around elbow. There are not enough data documenting the same amongst the Indians. We aimed to determine the relative distances of nerves around the elbow to the arthroscopy portals and risk of injury in different positions of the elbow.
Materials and Methods: Six standard elbow arthroscopy portals were established in 12 cadaveric upper limbs after joint distension. Then using standard dissection techniques all the nerves around the elbow were exposed, and their distances from relevant portals were measured using digital vernier caliper in 90° elbow flexion and 0° extension. Descriptive statistical analysis was used for describing distance of the nerves from relevant portal. Wilcoxon-signed rank test and Friedman’s test were used for comparison.
Results: There was no major nerve injury at all the portals studied in both positions of the elbow. The total incidence of cutaneous nerve injury was 8.3% (12/144); medial cutaneous nerve of forearm 10/48 and posterior cutaneous nerve of forearm 2/24. No significant changes were observed in the distance of a nerve to an individual portal at 90° flexion or 0° extension position of the elbow.
Conclusion: This study demonstrates the risk of injury to different nerves at the standard portals of elbow arthroscopy. In practice, the actual incidence of nerve injury may still be lower. We conclude that elbow arthroscopy is a safe procedure when all precautions as described are duly followed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Elfeddali R, Schreuder MH, Eygendaal D. Arthroscopic elbow surgery, is it safe? J Shoulder Elbow Surg 2013;22:647–52.
Steinmann SP, King GJ, Savoie FH 3rd. Arthroscopic treatment of the arthritic elbow. Instr Course Lect 2006;55:109–17.
Ruch DS, Poehling GG. Anterior interosseus nerve injury following elbow arthroscopy. Arthroscopy 1997;13:756–8.
Schneider T, Hoffstetter I, Fink B, Jerosch J. Long term results of elbow arthroscopy in 67 patients. Acta Orthop Belg 1994;60:378–83.
Kelly EW, Morrey BF, O’Driscoll SW. Complications of elbow arthroscopy. J Bone Joint Surg Am 2001;83-A: 25–34.
Sinha A, Pydah SK, Webb M. Elbow arthroscopy: A new setup to avoid visual paradox and improve triangulation. Arthrosc Tech 2013;2:e65–7.
Plancher KD, Bishai SK. Basics of elbow arthroscopy: Setup, portals, and technique. Tech Orthop 2006;21:239–49.
Marti D, Spross C, Jost B. The first 100 elbow arthroscopies of one surgeon: Analysis of complications. J Shoulder Elbow Surg 2013;22:567–73.
Yeoh KM, King GJ, Faber KJ, Glazebrook MA, Athwal GS. Evidence-based indications for elbow arthroscopy. Arthroscopy 2012;28:272–82.
Wijeratna M, Bailey KA, Pace A, Tytherleigh-Strong G, Van Rensburg L, Kent M. Arthroscopic radial head excision in managing elbow trauma. Int Orthop 2012;36:2507–12.
Tanaka N, Sakahashi H, Hirose K, Ishima T, Ishii S. Arthroscopic and open synovectomy of the elbow in rheumatoid arthritis. J Bone Joint Surg Am 2006;88:521–5.
Yan H, Cui GQ, Wang JQ, Yin Y, Ao YF. Arthroscopic debridement of osteoarthritic elbow in professional athletes. Chin Med J (Engl) 2011;124:4223–8.
Rosenberg BM, Loebenberg MI. Elbow arthroscopy. Bull NYU Hosp Jt Dis 2007;65:43–50.
Unlu MC, Kesmezacar H, Akgun I, Ogut T, Uzun I. Anatomic relationship between elbow arthroscopy portals and neurovascular structures in different elbow and forearm positions. J Shoulder Elbow Surg 2006;15:457–62.
Reddy AS, Kvitne RS, Yocum LA, Elattrache NS, Glousman RE, Jobe FW. Arthroscopy of the elbow: A long term clinical review. Arthroscopy 2000;16:588–94.
Kamineni S, Hamilton DA Jr. Arthroscopic ulnar nerve identification during posterior elbow arthroscopy. Arthrosc Tech 2012;1:e113–7.
Blonna D, Wolf JM, Fitzsimmons JS, O’Driscoll SW. Prevention of nerve injury during arthroscopic capsulectomy of the elbow utilizing a safety-driven strategy. J Bone Joint Surg Am 2013;95:1373–81.
Marshall PD, Fairclough JA, Johnson SR, Evans EJ. Avoiding nerve damage during elbow arthroscopy. J Bone Joint Surg Br 1993;75:129–31.
Maak TG, Osei D, Delos D, Taylor S, Warren RF, Weiland AJ. Peripheral nerve injuries in sports-related surgery: Presentation, evaluation, and management: AAOS exhibit selection. J Bone Joint Surg Am 2012;94:e1211–10.
Adolfsson L. Arthroscopy of the elbow joint: A cadaveric study of portal placement. J Shoulder Elbow Surg 1994;3:53–61.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
About this article
Cite this article
Chaware, P.N., Santoshi, J.A., Pakhare, A.P. et al. Risk of nerve injury during arthroscopy portal placement in the elbow joint. IJOO 50, 74–79 (2016). https://doi.org/10.4103/0019-5413.173510
Published:
Issue Date:
DOI: https://doi.org/10.4103/0019-5413.173510