Medial Approach to the Elbow joint

The medial approach to the elbow joint gives good exposure of the medial compartment of the joint.

  • Medial approach to the elbow joint can be enlarged to expose the anterior surface of the distal fourth of the humerus.
  • The uses of the medial approach to the elbow joint include the following:
    1. Decompression and/or transposition of the ulnar nerve.
    2. Ulnar removal of loose bodies.
    3. ORIF of the ulnar coronoid process.
    4. ORIF of the medial humeral condyle and epicondyle.
    5. Debridement and reattachment of common flexor wad for medial epicondylitis.

  • Supine with arm flexed and supported by arm board over the patient.

  • Landmarks:
    • Medial epicondyle of the humerus.
  •  Incision:
    • Make a Curved incision 8 to 10 cm long on the medial aspect of the elbow, Centered over the medial epicondyle.

  • Proximally between:
    • Brachialis muscle: which innervate by the musculocutaneous nerve.
    • Triceps muscle: which innervate by the radial nerve.
  • Distally between:
    • Brachialis muscle: which innervate by the musculocutaneous nerve.
    • Pronator teres muscle: which innervate by the median nerve.

  • Incise the fascia over the ulnar nerve starting proximally:
    • Isolate nerve along the entire length of the incision.
  • Expose the common flexor origin on the medial epicondyle.
  • Develop brachialis and PT interval.
  • Avoid the median nerve which enters PT near the midline.
  • If necessary can perform osteotomy of the medial epicondyle:
    • Osteotomy is reflected distally.
    • Ensure retained MCL ligament into osteotomy fragment.
  • Develop brachialis and triceps interval.

  • Incise capsule and medial collateral ligament.

  • Local:
    • Abduction of forearm opens medial aspect of joint.
    • Can dislocate laterally by dissecting off joint capsule and periosteum.
  • Proximal:
    • Anterior surface of distal fourth of humerus can be exposed by developing plane between brachialis and triceps muscles.
  • Distal:
    • Limited by the branches of the median nerve.

  • The structures at risk during the medial approach to the elbow joint includes:
    1. Ulnar nerve:
      • is at risk during approach.
      • must be dissected out to ensure protection.
    2. Median nerve:
      • Aggressive traction on the osteotomy fragment can cause a traction injury to the median and anterior interosseous nerves.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
The medial approach to the elbow joint The medial approach to the elbow joint The medial approach to the elbow joint The medial approach to the elbow joint The medial approach to the elbow joint The medial approach to the elbow joint The medial approach to the elbow joint The medial approach to the elbow joint The medial approach to the elbow joint
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