Elbow arthroscopy

    ELBOW ARTHROSCOPY - Source Miller Review 2012

       A        Indications

       1        This procedure is typically indicated for diagnostic confirmation of suspected elbow pathology; removal of loose bodies; treatment of osteochondritis dissecans of the capitellum; osteophyte débridement (as seen with chronic valgus overload in pitchers); capsular release and débridement of the olecranon, radial, and coronoid fossa in the stiff elbow; and synovectomy.

       2        Successful arthroscopic intervention depends on technical expertise in elbow arthroscopy and thorough anatomic familiarity because vital neurovascular structures are proximal to the intraarticular space and are thus prone to injury, particularly with overexuberant débridement.

       B        Risks

       1        The “nick and spread” method of portal placement is used to minimize inadvertent neurovascular injury.

       2        The use of far-proximal portals may decrease these risks. A posteromedial portal is least safe because of its proximity to the ulnar nerve.

       3        In patients with prior ulnar transposition and contractures, extra caution is needed.

       4        Other risks include injury to the ulnar nerve (proximal medial and posteromedial portals) and brachial artery injury with removal of loose bodies (anteriorly).

       5        The most common transient nerve palsy after elbow arthroscopy is an ulnar nerve palsy. Superficial radial nerve, posterior interosseous nerve, medial antebrachial cutaneous nerve, and anterior interosseous nerve palsies have also been reported.

       C        Portals

           Three portals are commonly used:

       ?        Anterolateral portal: placed after joint distension 1 cm distal and 1 cm anterior to the lateral epicondyle. The lateral antebrachial cutaneous and radial nerves are at risk.

       ?        Anteromedial portal: placed under direct visualization 2 cm distal and 2 cm anterior to the medial epicondyle. The medial antebrachial cutaneous and median nerves are at risk.

       ?        Posterolateral portal: placed 2 to 3 cm proximal to the olecranon and just lateral to the triceps tendon