Preoperative sonographic ulnar nerve mapping in the postoperative elbow
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TECHNICAL REPORT
Preoperative sonographic ulnar nerve mapping in the postoperative elbow Garret M. Powell 1 & Francis I. Baffour 1 & Michael R. Moynagh 1 & John A. Skinner 1 & Tiffany Keller Lam 2 & Shawn W. O’Driscoll 2 & Katrina N. Glazebrook 1 Received: 1 June 2020 / Revised: 14 September 2020 / Accepted: 17 September 2020 # ISS 2020
Abstract Objective To describe the technique of sonographic ulnar nerve mapping in the postoperative elbow for surgical planning. Materials and methods A retrospective review of a surgical databank identified 24 patients, all aged 18 years and older with a history of orthopedic elbow surgery, who were referred for preoperative sonographic mapping of the ulnar nerve prior to subsequent surgery. All cases were reviewed for patient demographics, clinical presentation, prior surgical interventions, and ultrasound technique. Charts were reviewed for intraoperative and postoperative outcomes, including nerve injury. Results The cohort included 12 males and 12 females with a mean age of 51 years (range 22–68 years) and a mean BMI of 29 (range 20–48). Preoperative sonographic ulnar nerve mapping occurred following various elbow surgeries including ulnar nerve transposition to assess nerve location prior to subsequent elbow surgery. Of the 24 patients with preoperative sonographic ulnar nerve mapping, subsequent surgery was performed arthroscopically in 14 and open in 10 cases. In 11 of the 24 cases, there was specific mention of a modified approach to joint access which was guided by the ulnar nerve map. There were no perioperative ulnar nerve–related complications, such as nerve transection. Conclusion Preoperative mapping can facilitate planning of surgical access and ulnar nerve dissection. Sonographic mapping of the ulnar nerve reduces the potential uncertainty of nerve palpation in a complex postoperative elbow following ulnar nerve transposition. This technique may mitigate the risk of ulnar nerve injury. Keywords Ulnar nerve mapping . Ultrasound . Postoperative elbow
Introduction Arthroscopic and open surgery of the elbow can be technically challenging in a postoperative elbow. Successful joint access and portal placement during arthroscopy of the elbow are of a higher degree of complexity compared to other joints [1], and suboptimal technique may result in iatrogenic peripheral nerve injury including nerve transection, compression, thermal damage, or nerve resection [2, 3]. During elbow arthroscopy, the ulnar nerve is most susceptible to injury, accounting for 38– 42% of all nerve injuries [4, 5]. * Francis I. Baffour [email protected] 1
Department of Radiology, Mayo Clinic, 200 1st St SW., Rochester, MN 55905, USA
2
Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW., Rochester, MN 55905, USA
Variant ulnar nerve path—including ulnar nerve transposition or ulnar nerve subluxation out of the cubital tunnel—was historically a contraindication to elbow arthroscopy due to a theoretical increase in the risk of iatrogenic nerve injury [6–9]. While operative reports
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