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Elbow Videos: Other
Arthroscopic Elbow Osteocapsular Arthroplasty
Treatment of primary elbow osteoarthritis in the young active patient less than 50 years old presents a treatment challenge to the practicing orthopaedic surgeon. Following failure of nonoperative management, surgical goals are aimed at reducing pain and improving joint mobility from bony impingement. Arthroscopic osteocapsular arthroplasty is a viable treatment option with few post-operative limitations. In contrast, total elbow arthroplasty is considered a salvage option in this patient population given the activity restrictions imposed.An Inexpensive Support for Prone or Lateral Decubitus Elbow Arthroscopy and Open Elbow Surgery
An inexpensive and radiolucent elbow can be built with a PVC pipe available at any home center or hardware store for less than $25 that allows elbow arthroscopy or open elbow surgery such as open reductions and internal fixation to be performed in the prone, “sloppy” lateral, or decubitus position.Endoscopic Anterior Subcutaneous Transposition of the Ulnar Nerve
Cubital tunnel syndrome refers to ulnar nerve compressive neuropathy and most commonly occurs at the level of the elbow. Surgical options include in situ decompression, decompression with anterior transposition of the ulnar nerve, and medial epicondylectomy with or without decompression. With the advancement of endoscopic surgery, techniques of endoscopic in situ decompression of the ulnar nerve, endoscopy-assisted anterior transposition, and endoscopic anterior transposition of the ulnar nerve have been reported with the advantage of minimally invasive surgery.Ultrasound-Assisted Posteromedial Portal Placement of the Elbow Joint to Prevent Ulnar Nerve Injury
Direct posterior and posterolateral portals are the standard portals used in posterior elbow arthroscopy. A posteromedial portal in the elbow is not recommended because of its proximity to the ulnar nerve. However, iatrogenic injuries to the ulnar nerve have been reported after elbow arthroscopy using the standard posterior portals, especially in posteromedial elbow joint pathologies. We present a surgical technique applicable to posteromedial elbow pathology by using ultrasound-assisted posteromedial portal placement of the elbow joint.Arthroscopic Excision of Osteoid Osteoma of the Elbow
Osteoid osteoma has been reported infrequently around the elbow joint, and is usually treated with radiofrequency ablation or open excision. Elbow arthroscopy is useful for excision of accessible lesions, and the accompanying elbow stiffness can be treated concurrently. This report describes an arthroscopic excision of an osteoid osteoma located in the juxta-articular distal humeral bone. An initial adhesiolysis and capsulectomy is performed to gain access to the region above the capitellar articular margin.Basics of Elbow Arthroscopy Part I: Surface Anatomy, Portals, and Structures at Risk
As our knowledge and technology advance, the indications for elbow arthroscopy continue to grow rapidly. During this expansion, a number of new portals have been described and reported using variable nomenclature and location descriptions. Accordingly, a comprehensive review of these portals is warranted. Given the concern for potential iatrogenic injury to surrounding neurovascular structures, a discussion of these critical nerves and vessels is also timely. In this work, we review pertinent surface anatomy; portal nomenclature, locations, and utility; and review distances to the nearest structures at risk.Basics of Elbow Arthroscopy Part II: Positioning and Diagnostic Arthroscopy in the Supine Position
The field of elbow arthroscopy has evolved significantly since the procedure was first introduced more than 30 years ago. As our knowledge and understanding grows, numerous technical modifications have been made to improve the safety and efficacy of elbow arthroscopy. One of the most significant modifications is the change from the supine hanging position to the supine-suspended position with the use of a mechanical arm holder. Currently, the supine-suspended and lateral decubitus positions are the 2 most commonly used techniques.Basics of Elbow Arthroscopy Part III: Positioning and Diagnostic Arthroscopy in the Lateral Decubitus Position
In recent years, arthroscopy has gained popularity as a preferred treatment of a multitude of pathologies affecting the elbow. Since its initial description in 1985, many modifications have been made as our knowledge and technology have advanced. Currently, the majority of arthroscopic procedures are performed in either the lateral decubitus or supine suspended position. In this work, we discuss the history, patient positioning, and key steps for performing elbow arthroscopy in the lateral decubitus position.Valgus Extension Overload: Arthroscopic Decompression in the Supine-Suspended Position
Elbow arthroscopy is a useful tool for managing diseases of the elbow, including valgus extension overload, when conservative treatments have failed. Arthroscopic access to the elbow in the supine-suspended position is simple and reproducible with the technique described in this report. Synovial tissue can be cleared, optimizing visualization of the anatomic structures in the elbow including the posterior ulnohumeral joint. This report describes, in detail, arthroscopy of the elbow in the supine-suspended position and basic principles for arthroscopic decompression of the posterior elbow for valgus extension overload.Arthroscopic Distal Triceps Repair
In this note, we describe an arthroscopic repair of a degenerative tear of the triceps using a suture weave and an anatomic footprint anchor. We are able to assess, debride, and anatomically repair the distal triceps to its insertion. Compared with open procedures, this arthroscopic repair offers lower morbidity, faster recovery, and improved cosmesis. Our goal was to improve the function and strength of the elbow through this arthroscopic surgical fixation.Arthroscopic Radial Head Implant Removal and Resection
Displaced radial head fractures are treated with open reduction and internal fixation using implants. Failure of fixation may occur in the presence of comminution and in multifragmentary fractures; open surgical approaches are necessary for removal of the implants and radial head resection. Arthroscopic radial head resection has been described as a minimally invasive and effective treatment for failed radial head fracture fixation; however, periarticular adhesions and prominent implants add to the complexity and technical difficulty of the procedure.Endoscopically Assisted Anterior Subcutaneous Transposition of Ulnar Nerve
Ulnar nerve compression at the elbow is the most common neuropathy of the upper extremity. Surgical options include in situ decompression, decompression with anterior transposition of the ulnar nerve, and medial epicondylectomy with or without decompression. With the advancement of endoscopic surgery, techniques of endoscopic in situ decompression of the ulnar nerve and endoscopic anterior transposition of ulnar nerve have been reported. This article describes a technique of endoscopically assisted anterior subcutaneous transposition of ulnar nerve that is composed of an open release and mobilization of the ulnar nerve at and distal to the cubital tunnel and endoscopic release and mobilization of the ulnar nerve proximal to the cubital tunnel.Endoscopic Excision of Supracondylar Humeral Spur for Decompression of the Median Nerve and Brachial Artery
The humeral supracondylar process and Struthers ligament comprise a relatively rare but well-known anatomic variant. They are usually asymptomatic but may produce clinical symptoms related to compression of the median nerve or brachial artery below the ligament. Previously, surgery has been performed with an open ligament release and supracondylar process excision. This article reports on the use of endoscopic findings and the method of ligament release and process excision. Endoscopy is a minimally invasive technique that provides excellent visualization and enables the surgeon to perform dissection with magnification and precision.Endoscopic Ganglionectomy of the Elbow
Resection of the ganglion of the elbow is indicated if the size or location of the cyst impairs function or causes significant pain. Arthroscopic decompression or endoscopic resection of the cyst is the minimally invasive surgical option. It has the potential advantage of better cosmetic results and less soft-tissue dissection. Endoscopic resection is indicated if the cyst is not communicating with the joint or the communication is not identifiable arthroscopically or if there is a long and narrow communication placing the cyst away from the elbow joint.Use of a Bone Graft Drill Harvester to Create the Fenestration During Arthroscopic Ulnohumeral Arthroplasty
The Outerbridge-Kashiwagi procedure, or ulnohumeral arthroplasty, was described in 1978 as a method of treating elbow arthritis by creating a fenestration in the olecranon fossa. This fenestration diminishes the likelihood of recurrent spurs in the olecranon fossa and coronoid fossa, without loss of structural bony strength. Arthroscopic techniques have now been developed to perform this procedure. We describe an efficient method of creating the fenestration between the olecranon fossa and coronoid fossa during an arthroscopic ulnohumeral arthroplasty, or Outerbridge-Kashiwagi procedure, that also reduces the amount of residual bone debris produced during the resection.Dry Arthroscopy of the Elbow
Dry arthroscopy is attractive because it affords an unsurpassed clarity of view and minimizes swelling. The elbow is a challenging joint to assess arthroscopically; however, dry arthroscopy has some particular benefits in the elbow. The primary benefit is the quality of the tissue definition, but dry arthroscopy also increases the working time for surgery by reducing swelling and results in less postoperative discomfort for the patient. With dry arthroscopy, all joint surfaces are covered in synovial fluid, which reflects light, to provide a clearer image of the joint surfaces and depth of field.Arthroscopic Correction of a Supracondylar Malunion in a Child
Malunions are a well-recognized complication of pediatric supracondylar humeral fractures. Results of corrective osteotomies vary, and complication rates have been reported to be as high as 40%. Considering the high rate of complications for malunion correction, we investigated the feasibility of arthroscopy. We present a technique for arthroscopic supracondylar osteotomy and percutaneous pinning. There are many advantages of an arthroscopic approach to malunion correction, including extension-type deformity correction, safe access to the anterior humerus, and minimal dissection and scarring; any intracapsular contracture can be addressed as well.The Spin Move: A Reliable and Cost-Effective Gowning Technique for the 21st Century
Operating room efficiency (ORE) and utilization are considered one of the most crucial components of quality improvement in every hospital. We introduced a new gowning technique that could optimize ORE. The Spin Move quickly and efficiently wraps a surgical gown around the surgeon's body. This saves the operative time expended through the traditional gowning techniques. In the Spin Move, while the surgeon is approaching the scrub nurse, he or she uses the left heel as the fulcrum. The torque, which is generated by twisting the right leg around the left leg, helps the surgeon to close the gown as quickly and safely as possible.Distal Triceps Knotless Anatomic Footprint Repair: A New Technique
Distal triceps rupture is a rare injury causing significant disability. Several techniques for treating distal triceps ruptures have been described using bone tunnels or suture anchors. More recent techniques have focused on re-creating the anatomic footprint of the distal triceps tendon. However, the increasing numbers of anchors used increase the risk to the articular surface, and all earlier techniques require knot tying and bulky knots beneath the thin posterior elbow soft-tissue envelope. We describe a technique combining the use of bone tunnels and a single suture anchor to create a knotless anatomic footprint repair of the distal triceps.Endoscopic Robotic Decompression of the Ulnar Nerve at the Elbow
Ulnar nerve entrapment can be treated by a number of surgical techniques when necessary. Endoscopic techniques have recently been developed to access the ulnar nerve by use of a minimally invasive approach. However, these techniques have been considered difficult and, many times, dangerous procedures, reserved for experienced elbow arthroscopic surgeons only. We have developed a new endoscopic approach using the da Vinci robot (Intuitive Surgical, Sunnyvale, CA) that may be easier and safer. Standardization of the technique was previously developed in cadaveric models to achieve the required safety, reliability, and organization for this procedure, and the technique was then used in a live patient.Elbow Arthroscopy: A New Setup to Avoid Visual Paradox and Improve Triangulation
Elbow arthroscopy is a useful diagnostic and therapeutic tool for various conditions. Conventional arthroscopy with the patient in the prone or lateral position where the screen is placed on the opposite side makes it difficult to interpret the image, results in visual paradox, and is associated with difficult triangulation. We present a modified setup for the operating room to help eliminate these problems and improve triangulation.Arthroscopic Ulnar Nerve Identification During Posterior Elbow Arthroscopy
Elbow arthroscopy has increased in popularity in the past 10 years for both diagnostic and therapeutic purposes. A major limiting factor faced by the elbow arthroscopist is the close proximity of the neurovasculature to the working field, with the risk of iatrogenic injury. Many arthroscopic procedures are less extensive than their open equivalents because of an inability to consistently and safely eliminate the risk of neural and vascular injury. Many open procedures in the posterior compartment of the elbow joint are not routinely performed arthroscopically.
