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KMID : 1037920220090010013
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Arthroscopy and Orthopedic Sports Medicine
2022 Volume.9 No. 1 p.13 ~ p.20
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Nerve injury after elbow arthroscopy during the surgeon’s learning curve
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Jeong Gu-Min
Park Seong-Cheol
Kim Han-Hoon
Lim Tae-Kang
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Abstract
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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.
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KEYWORD
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Elbow joint, Arthroscopy, Nerve injury, Complication, Learning curve
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