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Elbow Arthroscopy Made Simple: Indications and Techniques

      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.
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