Neurological Complications of Elbow Arthroscopy

Abstract

Elbow arthroscopy is an increasingly common procedure performed in orthopedic 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 post-operative neurological injury. All of these injuries were transient nerve injuries resolved without intervention. A recent report of major nerve injuries after elbow arthroscopy demonstrated that these injuries are likely under-reported in literature. A review of our records from 1998 to 2014 revealed six patients who had undergone elbow arthroscopy and developed neurological injury post-operatively. While complications after elbow arthroscopy are rare, the most common per- manent 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 chapter 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.