Laumonerie, Pierre

Abstract Based on the currently available literature, total denervation of the elbow joint is considered impossible. However, consensus with respect to the anatomic location of sensory branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the elbow joint, as well as the distribution of sensory receptors about its capsule. Four electronic databases were queried, between January 1945 and June 2019. Twenty‐one original articles providing a detailed description of the distribution of sensory receptors about the elbow joint capsule (5) and its articular branches (16) were reviewed. The posterior capsule was found to be primarily innervated by the ulnar and radial nerves via combined articular branches and sensory branches of the medial antebrachial cutaneous nerve. The anterior capsule was found to be primarily innervated by a plexus of articular ramifications from muscular branches of mixed nerves (ulnar, musculocutaneous, radial, and median nerves). A higher density of nociceptors and mechano‐receptors was identified within the posterior and anterior capsules, respectively. Thorough denervation, via the technique proposed herein, is likely to be sufficient in eliminating pain from degenerative conditions of the elbow joint.

Purpose To compare the accuracy of distal suprascapular nerve (dSSN) blockade performed with the use of ultrasound‐guided regional anesthesia (USRA) versus with a landmark‐based approach (LBA). A secondary aim was to describe the anatomic features of the sensory branches of the dSSN. Methods USRA and LBA were performed in 15 shoulders each from 15 cadavers (total of 30 shoulders). Then, 10 mL of methylene blue‒infused ropivacaine 0.75% was injected into the dSSN. Simultaneously, 2.5 mL of red latex solution was injected to identify the position of the needle tip. The division and distribution of the sensory branches originating from the SSN were described. Results The tip of the needle was identified at 1.3 cm (range, 0‐5.2 cm) and 1.5 cm (range, 0‐4.5 cm) with USRA and the LBA, respectively ( P = .90). Staining diffused past the origin of the most proximal sensory branch in 27 cases. The most proximal sensory branch arose 2.5 cm from the suprascapular notch. Among the 3 failures that occurred in the USRA group, the sensory branches also failed to be marked. All 30 dSSNs gave off 3 sensory branches, which innervated the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments. Conclusions An LBA is as reliable and accurate as US guidance for anesthetic blockade of the dSSN. Marking of the suprascapular nerve must be proximal to the suprascapular notch to involve the 3 sensory branches in the anesthetic blockade. Clinical Relevance The present study demonstrates that a landmark‐based approach to anesthetic blockade of the distal suprascapular nerve is accurate and can be performed by orthopaedic surgeons lacking experience in ultrasound‐guided anesthetic techniques.

Introduction The EVOLVE implant (Wright Medical Technology, Arlington, TN, USA) is a modular loose-fitting radial head prosthesis. The primary objective was to synthesize all available literature investigating the midterm clinical outcomes of the EVOLVE implant. Materials and methods An electronic literature search in Pubmed/Medline, Scopus, EMBASE, and Cochrane library was performed querying for studies published in 2000–2017. Articles describing clinical and radiographical outcomes as well as reoperation were included. Outcomes of interest included range of motion, Mayo Elbow Performance Score, Disabilities of the Arm Shoulder and Hand, radiographic outcome, and reason for reoperation. Results A total of five articles consisting of 146 patients with EVOLVE implants were included. Mean patient age was 57.4 years (range 22–84), and 43.8% were males (n = 64). Mean follow-up was 4.8 years (range 1–14). Mean Mayo Elbow Performance Score and Disabilities of the Arm Shoulder and Hand score were 87.6 (range 30–100) and 18.9 (range 0–82), respectively. Midterm clinical results were good or excellent (Mayo Elbow Performance Score > 74) in 94 patients. Reoperation was observed in 12 patients, with implant revision required in 2 patients. The primary reason for reoperation was persistent stiffness (n = 9). Conclusion Midterm outcomes of EVOLVE radial head prosthesis are satisfactory, and associated complication rates are low. Loose-fit implant method appears to be a reliable approach to avoid failure of radial head prosthesis by painful loosening.

Difficulty in identifying the susprascapular nerve (SSN) limits the success of US‐guided regional anesthetic injections. A proximal SSN block could be an effective and reliable approach. The primary objective was to validate the feasibility of the US‐guided proximal SSN block. The secondary objective was to quantify the spread of the colored local anesthetic to the phrenic nerve (PN). Fourteen brachial plexuses from seven cadavers were included. Characterization of the proximal SSN was performed using US to determine the diameter and depth of the origin of the SSN (orSSN). Ten mL of methylene blue‐infused ropivacaine 0.2% were then injected to the proximal portion of the SSN. After dissection, the distances between the tip of the needle and the orSSN and the PN were anatomically determined. The PN was also judged to be colored or not by the methylene blue. The mean diameter and depth of the orSSN were 0.2 cm (range, 0.1‐0.3 cm) and 1.5 cm (range, 0.6‐2 cm) respectively. The orSSN was successfully targeted in 14 of 14 specimens with US; the tip of the needle was a mean of 1.6 cm (range, 0.2‐2.5 cm) and 5.1 cm (range, 4‐6.5 cm) from the orSSN and PN respectively. The orSSN and PN were marked in 14 and 3 cases respectively. US‐guided proximal SSN block is effective and reliable. The origin of the SSN is an easily identifiable landmark. This regional anesthesia could also reduce the risk of phrenic nerve palsy following interscalene brachial plexus block. Clin. Anat. 31:824–829, 2018. © 2018 Wiley Periodicals, Inc.

Background In 2014, Delclaux et al described a case wherein the Battiston and Lanzetta's technique, modified by utilization of the posterior interosseus nerve (PIN), was used to perform double neurotization of the ulnar nerve (UN). This study evaluates the feasibility of transfer of proprioceptive fascicles of the PIN to the superficial sensory branch of the UN (SSBUN). Methods The surgeries were performed on 16 fresh cadaveric wrist specimens. PIN transfer was performed through the interosseous membrane and sutured to the SSBUN. The diameter for each nerve, number of fascicles, and the percentage of fascicles without axons, under ×10, ×40, and ×100 magnifications were performed by two observers. Results Neurotization of the SSBUN by the PIN was successful in all cases. The median diameter of the SSBUN and PIN was 3.5 (3–4) and 2.3 mm (1.6–3), respectively. The SSBUN contained 5.5 fascicles (4–7), while the PIN contained 2 fascicles (0–4). The 16 PIN had limited (10 cases) or no axonal reserve (6 cases). Conclusion This study supports the surgical and anatomical feasibility of neurotization of the SSBUN by the PIN. However, the PIN's limited axonal reserve may partially or totally compromise recovery.