William B. Stetson

By William B. Stetson, Kevin Vogeli, Brian Chung, Nicole J. Hung, Stephanie Morgan and Milan Stevanovic

Elbow arthroscopy is an increasingly common procedure performed in orthopedic surgery. However, due to the presence of several major neurovascular structures in close proximity to the operative portals, it can have potentially devastating complications. The largest series of elbow arthroscopies to date described a 2.5% rate of post-operative neurological injury. All of these injuries were transient nerve injuries resolved without intervention. A recent report of major nerve injuries after elbow arthroscopy demonstrated that these injuries are likely under-reported in literature. A review of our records from 1998 to 2014 revealed six patients who had undergone elbow arthroscopy and developed neurological injury post-operatively. While complications after elbow arthroscopy are rare, the most common permanent nerve palsy post-operatively is the posterior interosseous nerve (PIN) followed by the ulnar nerve. Because of the surrounding neurovascular structures, familiarity with the normal elbow anatomy and portals will decrease the risk of damage to important structures. The purpose of this chapter is to review important steps in performing elbow arthroscopy with an emphasis on avoiding neurovascular injury. With a sound understanding of the important bony anatomic landmarks, sensory nerves, and neurovascular structures, elbow arthroscopy can provide both diagnostic and therapeutic intervention with little morbidity.

Part of the book: Recent Advances in Arthroscopic Surgery

By William B. Stetson, Stephanie Morgan, Brian Chung, Nicole Hung, Genevieve Mazza and Alex McIntyre

The failed fusion between two acromial apophyses, called an os acromiale, is often asymptomatic and found incidentally during evaluation for unrelated shoulder pathology. Though this is frequently not the primary pain source, a mobile os acromiale fragment can cause inflammation at the pseudarthrosis site, rotator cuff impingement, or AC joint arthritis. Varying operative techniques exist with good to satisfactory results for symptomatic patients. Several operative techniques have been described including open excision, open reduction-internal fixation (ORIF), arthroscopic acromioplasty or subacromial decompression, and arthroscopic excision. Open excision of a meso-acromion can lead to persistent pain and deltoid weakness and atrophy. The management of a meso-acromial fragment with ORIF can also result in persistent pain and deltoid weakness and atrophy with nonunion of the fragments. Arthroscopic excision of the meso-acromion is described as a viable alternative for surgical candidates.

Part of the book: Recent Advances in Arthroscopic Surgery

By William B. Stetson, Katie Lutz and Kristen Reikersdorfer

Superior labral anterior to posterior (SLAP) tears in overhead athletes can be a career-ending injury because of the high failure rates with surgical intervention. There are many factors for this including the failure to establish the correct diagnosis, inadequate nonoperative management, the repair of normal variants of the superior labrum by inexperienced surgeons, and improper poor surgical technique. SLAP lesions rarely occur in isolation and can be associated with other shoulder disorders. The mechanism of injury can be an acute episode of trauma or a history of repetitive overhead use as in baseball pitchers or volleyball players. The physical exam findings can be confusing as these injuries often occur with other shoulder pathology. There is no single physical exam finding that is pathognomonic for SLAP tears. Nonoperative treatment should always be undertaken for a minimum of 3 months before surgery is recommended. If this fails to return the overhead athlete to competitive participation, a diagnostic arthroscopy with SLAP repair can yield excellent results if the proper technique is employed. The technique that we describe can be technically demanding but can be reproduced and give excellent results with a predictable return to play for overhead athletes.

Part of the book: Updates in Endoscopy