Carpenter Melissa L, Vega Jose F, Gerhold Cameron, Murray Michael J, Poulson Trevor A, Verma Nikhil N
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Video J Sports Med. 2025 Aug 14;5(4):26350254251334652. doi: 10.1177/26350254251334652. eCollection 2025 Jul-Aug.
Posterior elbow impingement is often seen in athletes who engage in overhead sports that involve repetitive elbow extension; for these patients with persistent symptoms, arthroscopic debridement is often recommended. While traditionally performed in the supine or prone position, arthroscopic elbow debridement performed in the lateral decubitus position has distinct advantages that make it our preferred method.
Arthroscopic debridement in the context of posterior elbow impingement is utilized when conservative management with rest, physical therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) does not provide improvement in pain or range of motion.
After induction of general anesthesia and placement of an interscalene block, the patient is placed on the operating table in the lateral decubitus position utilizing the arm holder of choice. The bony landmarks of the operative elbow are identified, and the joint capsule is insufflated with 25 mL of saline before placement of the arthroscopic portals. A diagnostic arthroscopy of the anterior and posterior compartments of the elbow is first performed. Debridement of loose bodies, inflammatory synovium, and capsular tissue is conducted as needed. Attention is then turned to the direct posterior working portal where the olecranon tip is identified. The posterior olecranon and olecranon fossa are thoroughly smoothed with a shaver to create a flush surface. Scope instrumentation is withdrawn, and the elbow is manipulated to ensure full range of motion.
It is the senior author's belief that management of posterior elbow impingement with arthroscopic debridement in the lateral decubitus approach provides enhanced visualization and allows free manipulation of the joint throughout the procedure. This facilitates direct treatment of the olecranon and olecranon fossa while permitting comprehensive evaluation of the joint for concomitant loose bodies and inflammatory synovium. Additionally, the risk of iatrogenic injury to nearby neurovascular structures while instrumenting the joint is diminished.
DISCUSSION/CONCLUSION: Arthroscopic debridement for posterior elbow impingement in the lateral decubitus position with the operative extremity supported proximally in an arm holder has been shown to optimize arthroscopic viewing of the joint. This technique also provides ease of access to the posterior compartment, thereby substantially and immediately increasing patient range of motion.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
后肘部撞击症常见于从事涉及重复性伸肘的过头运动的运动员；对于这些症状持续的患者，通常建议进行关节镜清创术。虽然传统上关节镜下肘部清创术是在仰卧位或俯卧位进行，但在侧卧位进行的关节镜肘部清创术有明显优势，使其成为我们首选的方法。
当通过休息、物理治疗和非甾体类抗炎药（NSAIDs）进行保守治疗后疼痛或活动范围没有改善时，可采用关节镜清创术治疗后肘部撞击症。
在全身麻醉诱导和进行肌间沟阻滞之后，使用选定的臂托将患者置于手术台上的侧卧位。确定手术肘部的骨性标志，在放置关节镜入路之前，向关节囊内注入25毫升生理盐水。首先对肘部的前后腔室进行诊断性关节镜检查。根据需要清除游离体、炎性滑膜和关节囊组织。然后将注意力转向直接后方工作通道，在此通道处确定鹰嘴尖。用刨刀将鹰嘴后部和鹰嘴窝彻底打磨光滑，以形成平整表面。撤出关节镜器械，活动肘部以确保其能进行全范围活动。
资深作者认为，采用侧卧位关节镜清创术治疗后肘部撞击症可提供更好的视野，并允许在整个手术过程中对关节进行自由操作。这便于直接处理鹰嘴和鹰嘴窝，同时可以全面评估关节内是否存在游离体和炎性滑膜。此外，在对关节进行器械操作时，对附近神经血管结构造成医源性损伤的风险降低。
讨论/结论：已证明，对于后肘部撞击症，采用侧卧位关节镜清创术，并在近端使用臂托支撑手术肢体，可优化关节镜对关节的观察视野。该技术还便于进入后腔室，从而显著并立即增加患者的活动范围。
作者证明已获得本出版物中出现的任何患者的同意。如果个人身份可识别，作者在提交本稿件以供发表时已包含患者的豁免声明或其他书面批准形式。
