Anatomic relationship between elbow arthroscopy portals and neurovascular structures in different elbow and forearm positions

Abstract

Twenty fresh codaveric elbows were used to evaluate the proximity of neurovascular structures to the six arthroscopic portals of the elbow at different positions. After distention of the joint, 4-mm Steinmann pins were introduced into the elbow from the portal's entry points. After surgical dissection, the proximity of the neurovascular structures to the pins was measured in 5 different positions. The radial nerve showed significant proximity to the anterolateral portal in full elbow flexion, full elbow extension, and forearm supination with 10%, 20%, and 10% nerve-pin contacts, respectively. The distance between the median nerve and medial portals was significantly decreased with full extension. This study demonstrated that the distance between the route of the scope and neurovascular structures might diminish significantly during elbow motion. Most of these movements are unavoidable in elbow arthroscopy, but maintaining certain positions for a considerable period of time or angulating the scope forcefully in these positions can cause nerve injury.