Speaker: Know anatomy, have systematic approach when performing elbow arthroscopy
Click Here to Manage Email Alerts
KOLOA, Hawaii — While arthroscopy can be used to thoroughly assess the elbow and treat multiple pathologies, a presenter here noted surgeons should know the pertinent anatomy of the elbow and have a systematic approach to avoid problems.
In his presentation at Orthopedics Today Hawaii, Felix H. “Buddy” Savoie III, MD, noted the indications for performing elbow arthroscopy are many, and surgeons should be able to perform elbow arthroscopy if their skill level allows.
“As long as we are operating below the complication curve, you are going to do well,” Savoie said.
Patient position
He added there are several acceptable patient positions when performing elbow arthroscopy, including prone, lateral and supine. Savoie noted the prone position is the preferred position as it allows the surgeon to pivot the shoulder into external rotation to access the lateral side of the elbow or internal rotation to access the medial side of the elbow if switching to an open technique.
While the lateral position can be popular among surgeons, Savoie said a special arm holder is required, which can make the procedure difficult if the surgeon wants to switch to an open technique.
“Many people that are my age and older started with supine,” Savoie said. “It is not good, and you cannot do much with it, so it is not helpful.”
Proper instrumentation
In terms of instrumentation, surgeons should have a standard 4-mm scope, and a 2.7-mm scope can be helpful occasionally, according to Savoie. While Savoie noted he uses gravity inflow, a pump can be used during elbow arthroscopy as long as the pressure and flow are kept low. He said that retractors should be used to create space, not pressure, and surgeons should use a 3.5-sized shaver. Although a hooded burr can be used to remove spurs, Savoie said surgeons should be sure not to wrap up tissue during the process because the nerves are close.
“Handheld instruments are helpful. You want to have a good locking grasper and a syringe to fill things up,” Savoie said. “A tourniquet is helpful. You do not have to use a tourniquet but, again, with the elbow, visualization is critical, and then only blunt trocars. No sharp trocars because you can get yourself in trouble using anything sharp about the elbow.”
Knowledge of the anatomy
In addition to proper tools, Savoie noted knowledge of the anatomy is also important and surgeons should be sure to mark the anatomy.
“I usually only mark the ulnar nerve because, as you touch the elbow and move it around, I always want to make sure that that mark is in place, and I know that that’s inside of the elbow. Do not put any portals where that nerve is,” he said.
While there are 10 portals that can be used at various times during elbow arthroscopy, Savoie said the five that surgeons need to know are the proximal anteromedial, proximal anterolateral, posterior central, posterior lateral and soft spot portals.
“If you get those five portals, you can do 90% of your arthroscopic procedures just knowing that,” Savoie said.
Collapse
Savoie FH 3rd. Elbow arthroscopy: Five tips to make it easier. Presented at: Orthopedics Today Hawaii; Jan. 8 - 12, 2023; Koloa, Hawaii.
Read more about
Click Here to Manage Email Alerts