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Nerve injury after elbow arthroscopy during the surgeon’s learning curve
Arthrosc Orthop Sports Med 2022;9:13-20
Published online May 1, 2022;  https://doi.org/10.14517/aosm22005
© 2022 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Gu Min Jeong1, Seong Cheol Park2, Han Hoon Kim1, Tae Kang Lim1

1Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, 2Department of Orthopedic Surgery, Seoul CM Hospital, Seoul, Korea
Correspondence to: Tae Kang Lim, https://orcid.org/0000-0001-8752-3987
Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, 68 Hangeulbiseok-ro, Nowongu, Seoul 01830, Korea. Tel: +82-2-970-8036, Fax: +82-2-970-2773, E-mail: shouldertk@gmail.com
Received March 8, 2022; Revised April 28, 2022; Accepted May 4, 2022.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: A major concern among elbow surgeons regarding the use of elbow arthroscopy is the risk of nerve injury. This study reports the incidence and risk factors of nerve injury after elbow arthroscopies performed by a single elbow surgeon during the learning curve.
Methods: This retrospective study reviewed consecutive series of 110 elbow arthroscopic surgeries performed by one beginner elbow surgeon between 2011 and 2018. Surgical procedures included extensor carpi radialis brevis tendon release, osteocapsular arthroplasty, fracture reduction and fixation, the lateral collateral ligament repair, and septic joint irrigation and debridement. The incidence involving nerves and their outcomes were recorded. Clinical outcomes were assessed using the visual analog scale for pain, Mayo Performance Elbow score, Disabilities of the Arm, Shoulder, and Hand, and SF-36 score.
Results: Nerve injury was observed in eight patients (7.3%) that included the superficial radial nerve (2 patients), the ulnar nerve (2 patients), lateral antebrachial cutaneous nerve (2 patients), median nerve (1 patient), and medial antebrachial cutaneous nerve (1 patient). All injuries were localized to sensory deficit and transient, except one patient with superficial radial nerve injury showing a permanent sensory deficit that was not resolving until 30 months postoperatively. Surgical procedures related to nerve injury included six osteocapsular arthroplasties, which included one release of extensor carpi radialis brevis tendon, and one fixation of the radial head fracture. Notably, most nerve injuries occurred in the latter half-period of the learning curve (six cases in between serial numbers 56 and 110) without statistically significant difference (P = 0.097).
Conclusion: A nerve injury occurred with an incidence rate of 7.3% during the surgeon’s learning curve, although most injuries involved only the sensory branch and were transient.
Keywords : Elbow joint; Arthroscopy; Nerve injury; Complication; Learning curve
References
  1. Desai MJ, Mithani SK, Lodha SJ, Richard MJ, Leversedge FJ, Ruch DS. Major peripheral nerve injuries after elbow arthroscopy. Arthroscopy 2016;32:999-1002.e8.
    Pubmed CrossRef
  2. Leong NL, Cohen JR, Lord E, Wang JC, McAllister DR, Petrigliano FA. Demographic trends and complication rates in arthroscopic elbow surgery. Arthroscopy 2015;31:1928-32.
    Pubmed CrossRef
  3. Werner BC, Fashandi AH, Chhabra AB, Deal DN. Effect of obe-sity on complication rate after elbow arthroscopy in a medicare population. Arthroscopy 2016;32:453-7.
    Pubmed CrossRef
  4. Kim SJ, Moon HK, Chun YM, Chang JH. Arthroscopic treatment for limitation of motion of the elbow: the learning curve. Knee Surg Sports Traumatol Arthrosc 2011;19:1013-8.
    Pubmed CrossRef
  5. Ahmad CS, Vitale MA. Elbow arthroscopy: setup, portal place-ment, and simple procedures. Instr Course Lect 2011;60:171-80.
  6. Bennett JM. Elbow arthroscopy: the basics. J Hand Surg Am 2013;38:164-7.
    Pubmed CrossRef
  7. O’Driscoll SW, Morrey BF. Arthroscopy of the elbow. Diagnostic and therapeutic benefits and hazards. J Bone Joint Surg Am 1992;74:84-94.
    Pubmed CrossRef
  8. Hilgersom NFJ, van Deurzen DFP, Gerritsma CLE, et al. Nerve injuries do occur in elbow arthroscopy. Knee Surg Sports Traumatol Arthrosc 2018;26:318-24.
    Pubmed CrossRef
  9. Kelly EW, Morrey BF, O’Driscoll SW. Complications of elbow arthroscopy. J Bone Joint Surg Am 2001;83:25-34.
    Pubmed CrossRef
  10. Nelson GN, Wu T, Galatz LM, Yamaguchi K, Keener JD. Elbow arthroscopy: early complications and associated risk factors. J Shoulder Elbow Surg 2014;23:273-8.
    Pubmed CrossRef
  11. Schneider T, Hoffstetter I, Fink B, Jerosch J. Long-term results of elbow arthroscopy in 67 patients. Acta Orthop Belg 1994;60:378-83.
  12. Vavken P, M?ller AM, Camathias C. First 50 pediatric and adolescent elbow arthroscopies: analysis of indications and complications. J Pediatr Orthop 2016;36:400-4.
    Pubmed CrossRef
  13. Blonna D, Wolf JM, Fitzsimmons JS, O’Driscoll SW. Prevention of nerve injury during arthroscopic capsulectomy of the elbow utilizing a safety-driven strategy. J Bone Joint Surg Am 2013;95:1373-81
    Pubmed CrossRef
  14. Lim TK, Koh KH, Lee HI, Shim JW, Park MJ. Arthroscopic d?bridement for primary osteoarthritis of the elbow: analysis of preoperative factors affecting outcome. J Shoulder Elbow Surg 2014;23:1381-7.
    Pubmed CrossRef
  15. Claessen FMAP, Kachooei AR, Kolovich GP, et al. Portal placement in elbow arthroscopy by novice surgeons: cadaver study. Knee Surg Sports Traumatol Arthrosc 2017;25:2247-54.
    Pubmed CrossRef
  16. Verhaar J, van Mameren H, Brandsma A. Risks of neurovascular injury in elbow arthroscopy: starting anteromedially or anterolaterally? Arthroscopy 1991;7:287-90.
    CrossRef
  17. Unlu MC, Kesmezacar H, Akgun I, Ogut T, Uzun I. Anatomic relationship between elbow arthroscopy portals and neurovascular structures in different elbow and forearm positions. J Shoulder Elbow Surg 2006;15:457-62.
    Pubmed CrossRef