Prevention of nerve injury during arthroscopic capsulectomy of the elbow utilizing a safety-driven strategy.
BACKGROUND
A major factor limiting the use of elbow arthroscopy for contracture release is concern regarding nerve injury. The purpose of this report is to document the risk of nerve injury in a large series of arthroscopic contracture releases utilizing a safety-driven strategy.


METHODS
A series of 502 arthroscopic elbow contracture releases (including 388 osteocapsular arthroplasties) performed in 464 patients by one surgeon was reviewed retrospectively. The safety-driven step-wise strategy had been carried out in a standardized sequence: (1) Get In and Establish a View, (2) Create a Space in Which to Work, (3) Bone Removal, and (4) Capsulectomy. Neurologic complications were assessed and were followed until resolution.


RESULTS
No patient had a permanent nerve injury. Twenty-four patients (5%) had a transient nerve injury, associated with prolonged tourniquet time, cutaneous dysesthesia attributed to open incisions, simultaneous ulnar nerve transposition, or retractor use. All nerve deficits resolved after one day to twenty-four months, with one patient lost to follow-up.


CONCLUSIONS
Utilizing the technique described, arthroscopic contracture release and debridement of the elbow was performed with a low risk of nerve injury.


METHODS
Therapeutic level III. See instructions for authors for a complete description of levels of evidence.
Department of Orthopaedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin Medical School, Largo Turati 62, Turin 10128, Italy.
Davide
D
Blonna
Jennifer Moriatis
JM
Wolf
James S
JS
Fitzsimmons
Shawn W
SW
O'Driscoll
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003286:Contracture / Q000209:etiology; D019299:Decompression, Surgical; D004551:Elbow Joint / Q000294:innervation* / Q000601:surgery*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D057913:Joint Capsule Release / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications; D054850:Osteophyte / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D014459:Ulnar Nerve / Q000293:injuries / Q000601:surgery; D055815:Young Adult