Safe Elbow arthroscopy portals and tips on how to avoid complications.

1. ELBOW
ARTHROSCOPY
PORTALS
SAFE
N. A. DARLIS, MD
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2. 11% transient nerve dysfunction
Ulnar > superficial radial> PIN = AIN = MABC
Kelly et al (Mayo), JBJS(A), 2001

3. It is not (only) the portals, stupid

4. Portal to nerve measurements
• Position of portals not unanimous
• No wrong portal; safe portal

7. Proximal is safer

10. Ulnar nerve
• Snapping ?
• Transposed ?
• Pre-existing neuropathy?
• Open ulnar n. identification

13. Direction matters

14. Orientation matters

15. Elbow flexion matters
Median/ Radial
nerve to bone distance

16. Joint distension matters
Median/ Radial
nerve to bone distance

17. Technique matters
• Scalpel through skin only
• Blunts afterward

18. Positioning

21. Where to start?

31. Anterior capsule is your friend

38. Shave facing the bone

39. Use retractors

40. Change viewing portal

43. Technique matters (again)
A swollen elbow is unlike
a swollen shoulder
• Low pressures
• No suction on shaver
• Be quick.

44. • Examine- palpate- draw
• Flex and insufflate
• Orient yourself
• Maintain anterior capsule integrity
– switch portals instead of creating new
– use retractors
– anterior release last
TAKE HOME MESSAGES
…THEN CUT

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YOU