Over the past several years, the indications for elbow arthroscopy have expanded. Currently, elbow arthroscopy is used for the removal of loose bodies, the treatment of lateral epicondylitis, synovectomy, the debridement of osteophytes, the evaluation of instability contracture release, and the treatment of osteochondritis dissecans1-5.
Although elbow arthroscopy is a relatively safe procedure, the prevalence of neurovascular complications has been reported to range from 0% to 14%1,3,6-9. In the literature, there have been a few reports of complete nerve transections during elbow arthroscopy6-9. We recently reported the case of a patient who presented from an outside institution after undergoing a revision arthroscopic contracture release that resulted in a complete transaction of the ulnar nerve10.
A thorough understanding of the elbow anatomy and how it is affected by certain abnormalities can reduce the risk of complications associated with elbow arthroscopy. Elbows with a posttraumatic contracture have a decreased compliance of the capsule, resulting in limited displacement of neurovascular structures with insufflation. These effects should be thoroughly considered during portal placement and capsular debridement, especially because most reported complications have occurred in patients with posttraumatic contractures6-11. On the medial side of the elbow, it is imperative that the location of the ulnar nerve be identified prior to the placement of medial-side portals. This can be done by means of direct palpation, ultrasonography, or open exposure12. Dodson et al. recommended avoiding an arthroscopic procedure if the patient has undergone a previous ulnar nerve transposition1.
If there has been previous surgery on the lateral aspect of the elbow, it has been suggested that an arthroscopic procedure not be attempted because of possible adherence of the radial nerve to …
Enter your JBJS login information below.