Basics of Elbow Arthroscopy Part II: Positioning and Diagnostic Arthroscopy in the Supine Position

Abstract

The field of elbow arthroscopy has evolved significantly since the procedure was first introduced more than 30 years ago. As our knowledge and understanding grows, numerous technical modifications have been made to improve the safety and efficacy of elbow arthroscopy. One of the most significant modifications is the change from the supine hanging position to the supine-suspended position with the use of a mechanical arm holder. Currently, the supine-suspended and lateral decubitus positions are the 2 most commonly used techniques. In this work, we discuss the history of the supine position, provide key points for proper patient positioning, and detail the steps of diagnostic elbow arthroscopy. It is our hope that this work will serve as an up-to-date review and summary of the most critical components of this procedure for emerging elbow arthroscopists.

Fig 1

(A) Patient undergoing arthroscopy of the right elbow is positioned on the operation theater table with the right arm initially extended on an arm board. (B) The extremity is prepped and draped in the usual sterile fashion, and the bracket for the arm holder is secured and overwrapped to prevent the extremity from slipping during the case. (C) It is then fixed to the arm holder over the patient's chest with the humerus directed perpendicular to the floor.

Fig 2

When the elbow is placed in the supine-suspended position for elbow arthroscopy, the standard anterior portals used to access the lateral side of this right elbow are easily visualized. The arm is secured across the patient's chest using a mechanical arm holder. (A) The standard lateral portals include the proximal anterolateral portal (PALP), midanterolateral portal (MALP), and the anterolateral portal (ALP). (B) When viewing from the PALP, the medial side of the anterior elbow is easily visualized. (C) By slightly withdrawing the camera, the remainder of the lateral side of the joint can be inspected.

Fig 3

(A) When viewing this right elbow from the posterior side, the direct posterior portal (DPP), the proximal lateral portal (PLP), and the direct lateral portal (DLP) can easily be seen. (B) With the camera in the PLP, the lateral gutter, radiocapitellar, and radioulnar joints are visualized. (C) From the PLP, the medial gutter can also be inspected.