Download median nerve and brachial artery neurovascular bundle at the elbow

MEDIAN NERVE AND BRACHIAL ARTERY NEUROVASCULAR BUNDLE AT THE ELBOW – DANGEROUS ANTERIOR
ANATOMY FOR THE ELBOW ARTHROSCOPIST
A Gupta, S Kamineni, H K Ankem, A A Amis
Department of Orthopaedics and Biomechanics, Imperial College, London, UK
INTRODUCTION
Arthroscopic capsulectomy is recognised to be a useful tool for the treatment of
contracted elbows. The ultimate success of this technique will play will be determined,
in most part, by how successful we are in avoiding nerve injuries. The reported
prevalence of neurologic complications after elbow arthroscopy has ranged from 0 to 14
percent, and widely believed to be under-reported. The arthroscopic surgeon needs to be
able to identify a safe zone within the elbow, free from neurovasculature, which is in
close proximity to some parts the capsule being resected. The knowledge of where these
str uctures are at risk of injury during such procedures will help to safeguard them. We
performed an anatomical study on fresh human cadaveric elbows to define a zone of
safety with regard to median nerve and brachial artery.
METHODS
Seventy fresh cadaveric elbows were studied for the anatomy of the median nerve and
brachial artery, with respect to the bony anatomy that is readily visible during elbow
arthroscopy. The bony landmarks utilised were the base width of the coronoid fossa,
width between the medial and lateral trochlea ridges at the level of the medial
epicondyle inferior margin, and the lateral rim width of the coronoid process. These
measurements were performed at 90 degrees of elbow flexion, which is the standard
arthroscopic position, and in pronation and supination.
RESULTS
The average width of the coronoid fossa base, trochlea and the lateral coronoid ridge
were 14.3mm (range 13.9mm to 14.6mm), 22.5mm(range 21.6mm to 22.9mm), and
7.4mm (range 7.1mm to 7.6mm) respectively. The average diameter of the
neurovascular bundle at the coronoid fossa base, trochlea and coronoid process was
8.6mm(range 8.2mm to 8.9mm), 8.4mm (range 7.9mm to 8.6mm), and 8.3mm(range
8.0mm to 8.5mm), respectively. The neurovascular bundle lies 1.6mm (range 1.4mm to
1.9mm) medial to the coronoid fossa base, 2.4mm (range 2.1mm to 2.9mm) lateral to
the medial trochlea ridge and 2.2 mm (range 1.9mm to 2.5 mm) medial to the tip of the
coronoid process.
DISCUSSION
The median nerve is a structure at risk when performing elbow arthroscopy of the
anterior compartment. Our data supports the concept of a safe corridor of anterior elbow
arthroscopic surgery. The corridor of safety encompasses a lateral margin for the radial
nerve, the subject of an accompanying submission. The medial margin for this anterior
corridor spans the midpoint of the coronoid fossa, the trochlea groove, and the apex of
the coronoid process. This corridor is safe of neurovascular structures in all seventy
cadaveric elbows and forms a useful zone for anterior elbow surgery.
5th Combined Meeting of the Orthopaedic Research Societies of Canada, USA, Japan and Europe
Poster No: 178