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Scientific Articles   |    
Prevention of Nerve Injury During Arthroscopic Capsulectomy of the Elbow Utilizing a Safety-Driven Strategy
Davide Blonna, MD1; Jennifer Moriatis Wolf, MD2; James S. Fitzsimmons, BSc3; Shawn W. O’Driscoll, MD, PhD, FRCS(C)3
1 Department of Orthopaedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin Medical School, Largo Turati 62, Turin 10128, Italy
2 New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-4037
3 Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905. E-mail address for S.W. O’Driscoll: odriscoll.shawn@mayo.edu
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  • Disclosure statement for author(s): PDF

Investigation performed at the Mayo Clinic, Rochester, Minnesota

Davide Blonna, MD, and Jennifer Moriatis Wolf, MD, contributed equally to the preparation of this article.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Aug 07;95(15):1373-1381. doi: 10.2106/JBJS.K.00972
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Abstract

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.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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