Impacts of the elbow in different positions on the displacement of median nerve and radial nerve: an X-ray evaluation

doi:10.3969/j.issn.2095-4344.2016.33.007

Abstract

Abstract:

BACKGROUND: The position of median and radial nerves corresponding to elbow is usually estimated by macroscopical measurements, but there are big data errors when the elbow is bent.
OBJECTIVE: To measure and analyze the impacts of elbows in different positions on median and radial nerves under X-ray.
METHODS: Ten fresh frozen upper limb specimens were selected. The distance of median and radial nerves to the osseous marks inside the elbow was measured when the elbow was in extension, extension-half pronation, bent at flexion 90 degrees and bent at 90 degrees with the injection of normal saline into the joint capsule, respectively.
RESULTS AND CONCLUSION: The positions of median and radial nerves were not influenced when the elbow was in extension or in extension-half pronation (P > 0.05). The distance of median and radial nerves to the osseous mark of the elbow was significantly lengthened when the elbow was moved from from extension to was bent at 90 degrees (P < 0.05). The intra-articular injection of normal saline when the elbow flexion 90 degrees significantly elongated the distance of median and radial nerves to the osseous mark of elbow (P < 0.05). These results suggest that the elbow in different positions can induce the displacement of median and radial nerves. In addition, the distance between median, radial nerves and the osseous marks of the elbow is obviously lengthened when the elbow is in flexion with intra-articular injection of normal saline.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Elbow Joint, Median Nerve, Radial Nerve, Tissue Engineering

CLC Number:

R318

Lu Wei, Li Jian-ping, Qin Yi, Jiang Zhen-dong, Yang Lin. Impacts of the elbow in different positions on the displacement of median nerve and radial nerve: an X-ray evaluation[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(33): 4913-4918.

Figures/Tables 1

2.1 肘关节处于不同位置及关节囊内注射生理盐水对正中神经位置的影响正中神经与肱骨滑车内侧缘宽度/肱骨滑车宽度的百分比在伸直位(21±12)%和90°屈曲位(18±11)%差异无显著性意义(P=0.575)；前臂伸直位与伸直半旋前位正中神经与肱骨滑车内侧缘宽度/肱骨滑车宽度的百分比差异无显著性意义(P > 0.05)；肘关节屈90°及关节囊内注射生理盐水时增加正中神经与冠突尖及桡神经与桡骨头的距离。正中神经与肱骨滑车前缘的距离伸直位为(4.7± 1.5) mm，在屈90°位为(8.2±2.2) mm，两者相互比较差异有显著性意义(P < 0.001)，而在屈90°位关节囊注射生理盐水增加到(13.4±3.6) mm，与注射生理盐水前比较差异有显著性意义(P=0.001)；正中神经与尺骨冠突尖的距离伸直位为(5.3±1.4) mm，关节屈90°为(9.6± 2.3) mm，两者差异有显著性意义(P < 0.001)，在关节囊内注射生理盐水后增加到(12.9±3.9) mm，与注射生理盐水前比较，两者差异有显著性意义(P=0.037)，见图1，表1。 2.2 肘关节处于不同位置及关节囊内注射生理盐水对桡神经位置的影响肱骨小头外侧缘的距离/肱骨小头宽度的百分比在肘关节伸直位与伸直半旋前位以及屈90°与屈90°注射生理盐时相互比较，差异无显著性意义(P > 0.05)；当肘关节屈曲时会引起桡神经向内侧移位，肘关节伸直位桡神经与肱骨小头外侧缘的距离/肱骨小头宽度的百分比(68±10)%与屈曲位(97±17)%相互比较，差异有显著性意义(P < 0.01)；桡神经与桡骨头前缘的距离伸直位为(5.9±1.8) mm而屈90°为(10.7± 3.4) mm，两组相互比较差异有显著性意义(P=0.001)；屈90°注射生理盐水后增加至(17.0±4.2) mm与注射前比较，差异有显著性意义(P=0.002)。肘关节90°屈曲桡神经到桡骨头前缘的距离(7.8±1.8) mm与伸直位比较(5.4±2.0) mm，差异无显著性意义(P=0.009)；在屈90°位关节内注射生理盐水后增加到(11.9±3) mm，与屈90°位比较差异有显著性意义(P=0.013)，见图2，表2。"

References

[1] Hackl M, Lappen S, Burkhart KJ, et al. Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations. Clin Orthop Relat Res.2015;11(473):3627-3634.
[2] Tang H C,Xiang M,Chen H,et al. Arthroscopic surgery for the treatment of stiff elbow. Zhongguo Gu Shang. 2014;11(27):943-947.
[3] Kayalar M,Ozerkan F,Bal E,et al. Elbow arthrolysis in severely stiff elbows. Arch Orthop Trauma Surg.2008；10(128):1055-1063.
[4] Wegmann K, Lappen S, Pfau DB,et al. Course of the radial nerve in relation to the center of rotation of the elbow--the need for a rational safe zone for lateral pin placement. J Hand Surg Am. 2014;39(6):1136-1140.
[5] Hackl M,Lappen S,Burkhart K J,et al. The course of the median and radial nerve across the elbow: an anatomic study. Arch Orthop Trauma Surg.2015; 7(135):979-983.
[6] Rhee YG,Cho NS,Lim CT,et al. Debridement arthroplasty for post-traumatic stiff elbow: intraoperative factors affecting the clinical results of surgical treatment. Clinics in orthopedic surgery.2009; 1(1):27-33.
[7] Kim SJ, Moon HK, Chun YM,et al.Arthroscopic treatment for limitation of motion of the elbow: the learning curve. Knee Surg Sports Traumatol Arthrosc. 2011;6(19):1013-1018.
[8] Pederzini LA, Nicoletta F, Tosi M,et al. Elbow arthroscopy in stiff elbow. Knee Surg Sports Traumatol Arthrosc.2014;2(22):467-473.
[9] Gohlke F. The stiff elbow joint. Orthopade.2011;4(40): 281-283.
[10] Ersen A,Demirhan M,Atalar AC,et al. Stiff elbow: distraction interposition arthroplasty with an Achilles tendon allograft: long-term radiological and functional results. Acta orthopaedica et traumatologica turcica. 2014；5(48):558-562.
[11] 王虎,蔡道章.肘关节镜入路选择的应用解剖研究[J].中国临床解剖学杂志,2007,4(25):369-372.
[12] 陈光兴,唐康来,杨柳,等.关节镜下肘关节松解术[J].中华骨科杂志,2006,8(26):512-524.
[13] 蔡江瑜,王伟,范存义.肘关节开放松解联合内固定取出术治疗创伤后关节僵硬[J].中国修复重建外科杂志,2015; 29(7): 826-830.
[14] Sahajpal D, Choi T, Wright T W. Arthroscopic release of the stiff elbow. J Hand Surg Am. 2009;34(3): 540-544.
[15] Koh KH,Lim TK,Lee HI,et al. Surgical release of elbow stiffness after internal ?xation of intercondylar fracture of the distal humerus.JShoulder Elbow Surg. 2013; 22(2):268-274.
[16] Pederzini L A,Nicoletta F,Tosi M, et al. Elbow arthroscopy in stiff elbow. Knee Surg Sports Traumatol Arthrosc.2014;2(22):467-473.
[17] 唐浩琛,向明,陈杭,等. 关节镜下治疗肘关节僵硬[J].中国骨伤, 2014;11(27):943-947.
[18] 黄竞敏,赵力,唐建军,等. 关节镜下松解及清理术在肘关节屈伸功能障碍方面的应用[J].中华骨科杂志,2005; 25(9): 533-536.
[19] 闫飞, 王忠远,张湘生,等.关节镜治疗肘骨关节病[J].中国内镜杂志,2010; 16(1):93-95.
[20] Achtnich A, Forkel P, Metzlaff S, et al. Arthroscopic arthrolysis of the elbow joint. Oper Orthop Traumatol. 2013;25:205–214.
[21] Lindenhovius AL,Jupiter JB. The posttraumatic stiff elbow: a review of the literature. J Hand Surg Am. 2007;10(32):1605-1623.
[22] Chen S,Yu SY,Yan H,et al.The time point in surgical excision of heterotopic ossification of post-traumatic stiff elbow: recommendation for early excision followed by early exercise. J Shoulder Elbow Surg.2015; 8(24): 1165-1171.
[23] 蔡江瑜,王伟,范存义.肘关节开放松解术后并发症的研究进展[J].中国修复重建外科杂志,2015,29(1):113-117.
[24] Keener J D, Galatz L M . Arthroscopic management of the stiff elbow. J Am Acad Orthop Surg. 2011; 19(5): 265-274.
[25] Stothers K, Day B, Regan WR. Arthroscopy of the elbow: anatomy, portal sites, and a description of the proximal lateral portal. Arthroscopy.1995;8(11):449–457.
[26] Tucker SA,Savoie FH Rd,O'Brien MJ. Arthroscopic management of the post-traumatic stiff elbow. J Shoulder Elbow Surg.2011;2(20):83-89.
[27] Omid R, Hamid N, Keener JD,et al.Relation of the radial nerve to the anterior capsule of the elbow: anatomy with correlation to arthroscopy. Arthroscopy. 2012;13(28):1800-1804.
[28] Nandi S,Maschke S,Evans P J,et al. The stiff elbow. Hand (N Y).2009;4(4):368-379.
[29] Gallucci G L,Boretto JG,Davalos MA,et al. The use of dynamic orthoses in the treatment of the stiff elbow. 2014;8(24):1395-1400.
[30] Unlu MC,Kesmezacar H,Akgun I,et al.Anatomic relationship between elbow arthroscopy portals and neurovascular structures in different elbow and forearm positions. J Shoulder Elbow Surg.2006; 22(15):457-462.
[31] Haapaniemi T,Berggren M,Adolfsson L.Complete transection of the median and radial nerves during arthroscopic release of post-traumatic elbow contracture. Arthroscopy.1999;5(15):784-787.
[32] Singh H,Nam KY,Moon YL. Arthroscopic management of stiff elbow. Orthopedics.2011;6(34):167-169.
[33] Lichtenberg S.Elbow contracture. Use of an arthroscopic procedure or an an open procedure? . Obere Extremitat.2014;13(9):163-171.
[34] Morimoto D,Isu T,Kim K,et al. Proximal Entrapment Neuropathy of the Median Nerve above the Elbow-Case Report. J Nippon Med Sch.2015;6(82): 287-289.