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Elbow Arthroscopy Made Simple: Indications and Techniques
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Elbow Arthroscopy Made Simple: Indications and Techniques Jace Smith, M.D., and Larry D. Field, M.D.
1952
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 35, No 7 (July), 2019: pp 1952-1953
INFOGRAPHIC
1953
Abstract: Elbow arthroscopy is a technically demanding procedure. A comprehensive understanding of the elbow neurovascular anatomy combined with a very detail-oriented technique for portal placement helps to minimize risk and facilitates performing elbow arthroscopic procedures effectively and safely for the appropriate indications. The technique for establishing all portals is critical regardless of which portals are used. Care should be taken to thoroughly palpate the bony landmarks before establishing any portal site, and only blunt trocars should be used for elbow arthroscopy. Identification of the ulnar nerve is critical to avoid nerve injuries. In addition, only the skin should be incised, with a hemostat used to dissect through deeper tissues, in an effort to protect the superficial nerves. Likewise, although accurately measuring distances from the bony landmarks is important when planning portal-site locations, elbow sizes and shapes are highly variable. Therefore, recognition of an individual patient’s body size and habitus is a key step before establishing portals. The use of anterior proximal portals also allows for improved visualization of anterior structures in a safe manner (distant from nerves). Finally, insufflating the elbow joint before establishing the initial anterior compartment portal has been reported to increase the distances of the nerves from the portal-site cannulas. An additional reason to consider insufflating the joint before portal placement is that insufflation increases anterior capsular tension, making penetration of the capsule with the blunt trocars easier and more reliable. In summary, elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint.
Bibliography Adams JE, King G, Steinmann SP, Cohen MS. Elbow arthroscopy: Indications, techniques, outcomes, and complications. J Am Acad Orthop Surg 2014;22:810819. Bennett JM. Elbow arthroscopy: The basics. J Hand Surg Am 2013;38:164-167. Erickson BJ, Chalmers PN, Cvetanovich GL, Frank RM, Romeo AA, Harris JD. Quality and quantity of the elbow arthroscopy literature: A systematic review and meta-analysis. Am J Orthop 2016;45:E290E298.
Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material. Received May 9, 2019; accepted May 9, 2019.
Field LD. Beware the radial nerve: More elbow arthroscopy portals, more options. Arthroscopy 2017;33:1986-1987. Marti D, Spross C, Jost B. The first 100 elbow arthroscopies of one surgeon: Analysis of complications. J Shoulder Elbow Surg 2013;22:567-573. Omid R, Hamid N, Keener JD, Galatz LM, Yamaguchi K. Relation of the radial nerve to the anterior capsule of the elbow: Anatomy with correlation to arthroscopy. Arthroscopy 2012;28:1800-1804. Thon S, Gold P, Rush L, O’Brien MJ, Savoie FH. Modified anterolateral portals in elbow arthroscopy: A cadaveric study on safety. Arthroscopy 2017;33:1981-1985.
Address correspondence to Larry D. Field, M.D., Mississippi Sports Medicine and Orthopaedic Center, 1325 E Fortification St, Jackson, MS 39202, U.S.A. E-mail: lfi[email protected] Ó 2019 by the Arthroscopy Association of North America 0749-8063/19602/$36.00 https://doi.org/10.1016/j.arthro.2019.05.014
Elbow Arthroscopy Made Simple: Indications and Techniques Jace Smith, M.D., and Larry D. Field, M.D.
1952
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 35, No 7 (July), 2019: pp 1952-1953
INFOGRAPHIC
1953
Abstract: Elbow arthroscopy is a technically demanding procedure. A comprehensive understanding of the elbow neurovascular anatomy combined with a very detail-oriented technique for portal placement helps to minimize risk and facilitates performing elbow arthroscopic procedures effectively and safely for the appropriate indications. The technique for establishing all portals is critical regardless of which portals are used. Care should be taken to thoroughly palpate the bony landmarks before establishing any portal site, and only blunt trocars should be used for elbow arthroscopy. Identification of the ulnar nerve is critical to avoid nerve injuries. In addition, only the skin should be incised, with a hemostat used to dissect through deeper tissues, in an effort to protect the superficial nerves. Likewise, although accurately measuring distances from the bony landmarks is important when planning portal-site locations, elbow sizes and shapes are highly variable. Therefore, recognition of an individual patient’s body size and habitus is a key step before establishing portals. The use of anterior proximal portals also allows for improved visualization of anterior structures in a safe manner (distant from nerves). Finally, insufflating the elbow joint before establishing the initial anterior compartment portal has been reported to increase the distances of the nerves from the portal-site cannulas. An additional reason to consider insufflating the joint before portal placement is that insufflation increases anterior capsular tension, making penetration of the capsule with the blunt trocars easier and more reliable. In summary, elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint.
Bibliography Adams JE, King G, Steinmann SP, Cohen MS. Elbow arthroscopy: Indications, techniques, outcomes, and complications. J Am Acad Orthop Surg 2014;22:810819. Bennett JM. Elbow arthroscopy: The basics. J Hand Surg Am 2013;38:164-167. Erickson BJ, Chalmers PN, Cvetanovich GL, Frank RM, Romeo AA, Harris JD. Quality and quantity of the elbow arthroscopy literature: A systematic review and meta-analysis. Am J Orthop 2016;45:E290E298.
Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material. Received May 9, 2019; accepted May 9, 2019.
Field LD. Beware the radial nerve: More elbow arthroscopy portals, more options. Arthroscopy 2017;33:1986-1987. Marti D, Spross C, Jost B. The first 100 elbow arthroscopies of one surgeon: Analysis of complications. J Shoulder Elbow Surg 2013;22:567-573. Omid R, Hamid N, Keener JD, Galatz LM, Yamaguchi K. Relation of the radial nerve to the anterior capsule of the elbow: Anatomy with correlation to arthroscopy. Arthroscopy 2012;28:1800-1804. Thon S, Gold P, Rush L, O’Brien MJ, Savoie FH. Modified anterolateral portals in elbow arthroscopy: A cadaveric study on safety. Arthroscopy 2017;33:1981-1985.
Address correspondence to Larry D. Field, M.D., Mississippi Sports Medicine and Orthopaedic Center, 1325 E Fortification St, Jackson, MS 39202, U.S.A. E-mail: lfi[email protected] Ó 2019 by the Arthroscopy Association of North America 0749-8063/19602/$36.00 https://doi.org/10.1016/j.arthro.2019.05.014