Avoiding Neurological Complications of Elbow Arthroscopy

Abstract

Elbow arthroscopy is an increasingly common procedure performed in orthopaedic surgery. However, due to the presence of several major neurovascular structures in close proximity to the operative portals it can have potentially devastating complications. The largest series of elbow arthroscopies to date described a 2.5% rate of neurological injury after elbow arthroscopy. All of these injuries were transient nerve injuries and resolved without intervention. A recent report of major nerve injuries after elbow arthroscopy demonstrated that these injuries are likely under-reported in the literature.

A retrospective review of the medical records was performed at our institutions for patients who had undergone elbow arthroscopy and had documented neurological deficits post-operatively. Charts were analyzed for the original indication for elbow arthroscopy, the documented neurological injury, and any additional surgeries undertaken to address these injuries.

A review of our records from 1998 to 2014 revealed six patients who had undergone elbow arthroscopy and developed neurological injury post-operatively. Four out of the six patients (66%) had a documented permanent posterior interosseous nerve (PIN) palsy. Two out of six patients (33%) developed a permanent ulnar nerve palsy.

While complications after elbow arthroscopy are rare, the most common permanent nerve palsy post-operatively is the posterior interosseous nerve (PIN) followed by the ulnar nerve. Because of the surrounding neurovascular structures, familiarity with the normal elbow anatomy and portals will decrease the risk of damage to important structures. The purpose of this paper is to review important steps in performing elbow arthroscopy with an emphasis on avoiding neurovascular injury. With a sound understanding of the important bony anatomic landmarks, sensory nerves, and neurovascular structures, elbow arthroscopy can provide both diagnostic and therapeutic intervention with little morbidity.