Elsevier

JSES International

Volume 4, Issue 4, December 2020, Pages 1031-1036
JSES International

Elbow
Arthroscopic localization of the ulnar nerve behind the medial capsule is unreliable

https://doi.org/10.1016/j.jseint.2020.06.001Get rights and content
Under a Creative Commons license
open access

Purpose

Ulnar nerve injury is the most common neurologic complication of elbow arthroscopy. The purpose of this cadaveric study was to quantify the ability of surgeons to locate the ulnar nerve behind the posteromedial capsule during elbow arthroscopy using sole arthroscopic vision.

Methods

Twenty-one surgeons were asked to pin the ulnar nerve at the medial gutter and the posteromedial compartment using arthroscopic visualization of the medial capsule only. Pinning of the ulnar nerve was performed from extra-articular. Then, the cadaveric specimens were dissected and the shortest distances between the pins and ulnar nerve measured.

Results

Median pin-to-nerve distances at the medial gutter and posteromedial compartment were 0 mm (interquartile range [IQR], 0-3 mm) and 2 mm (IQR, 0-6 mm), respectively. The ulnar nerve was pinned by 11/21 surgeons (52%) at the medial gutter, and 7/21 surgeons (33%) at the posteromedial compartment. Three of 21 surgeons (14%) pinned the ulnar nerve at both the medial gutter and the posteromedial compartment. Surgeon's experience and operation volume did not affect these outcomes (P > .05).

Conclusions

Surgeons' ability to locate the ulnar nerve behind the posteromedial capsule using sole arthroscopic visualization, without external palpation, is poor. We recommend to proceed carefully when performing arthroscopic procedures in the posteromedial elbow, and identify and mobilize the ulnar nerve prior to any posteromedial capsular procedures.

Level of Evidence

Anatomy Study
Cadaver Dissection

Keywords

Elbow
ulnar nerve
arthroscopy
nerve injury
complication
prevention

Cited by (0)

No institutional review board approval is required for cadaveric studies at our institution. The cadaveric specimens used in this study were derived from bodies that entered the department of anatomy, University of Utrecht, through a donation program. From these persons written consent was obtained during life that allowed the use of their entire bodies for educational and research purposes.

The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Elbow Study Collaborative: Roger van Riet, Mark Wagener, Jaap Willems, Bertram The, Nicole Heesakkers, Wouter Jak, Aoon Covo, Sjaak Kodde, Eelco Nelissen, Andras Heijink, Frank Rahusen, Lex Boerboom, Oetze van der Meer, Carina Gerritsma, Roel Bisschop, Duarte Cadavez, Bart Boesenach, Anne Spaans, Ruud van Hove, Jose Acuna, Leon Diederix, Bertram The, Jean-Florin Ciornohac, Pablo Canales.