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Basic Knowledge to Improve Your Confidence in Elbow Arthroscopy

March 01, 2017

Contributors: Davide Blonna, MD; Enrico Bellato, MD; Francesco Caranzano, MD; Filippo Castoldi, MD; Roberto Rossi, MD

The aim of this educational video is to describe the key points in elbow arthroscopy in order to improve the surgeon’s self-confidence during this procedure with a specific emphasis on how to avoid nerve injury. A correct operating room and patient’s set up is mandatory for a safe procedure: we prefer the lateral decubitus since it allows free assessment of the intraoperative range of motion and full access to the airway and does not need traction. Drawing the anatomical landmarks on the skin can be useful. Ulnar nerve prophylactic decompression is usually indicated, in particular in cases of stiff elbow. The procedure starts from the posterior compartment. Several posterior portals are available, with the posterior, the posterolateral, the accessory posterolateral, and the soft spot portals being the most frequently used. The procedure in the anterior compartment is less safe since all the three main nerves around the elbow are at risk of injury. The anteromedial portals are the first to be performed. The anterolateral portals are the most dangerous since they are very close to the radial nerve, which lies over the anterior capsule at the level of the mid portion of the radial head. For safety reasons, these portals are usually performed under direct visualization from inside the joint.

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