Anterolateral approach to the ellbow
approaches FMH
approaches FMH
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Lernkarten
Indications
distal biceps avulsion
neural compressions involving
PIN syndrome
Radial tunnel syndrome
Superficial radial nerves
total elbow replacements
elbow joint I&D
surgery of capitellum (ORIF, aseptic necrosis)
excision of tumors
Intermuscular plane
Proximally bwtween:
brachialis (musculocutaneous n.)
brachioradialis (radial nerve)
Distally between
brachioradialis (radial nerve)
pronator teres (median nerve)
Incision
Incision
Make curved incision starting 5 cm proximal to flexion crease along the lateral border of the biceps
Continue distally by following medial border of the brachioradialis
Superficial dissection
Superficial dissection
Identify lateral antebrachial cutaneous nerve (sensory branch of the musculocutaneous nerve which becomes superficial 2 inches proximal to the elbow crease, lateral to the biceps tendon)
Incise the deep fascia along the medial border of the brachioradialis
Identify radial nerve proximally at level of the elbow joint (between brachialis and brachioradialis)
Follow the radial nerve distally until it divides into its three main branches:
PIN (enters the supinator)
sensory branch (travels deep to brachioradialis)
motor branch to ECRB
Develop brachiaradialis and PT interval distal to the division of the radial nerve.
Ligate recurrent branches of the radial artery and muscular branches that enter the brachialis just below the elbow to allow better retraction
Deep dissection
Deep dissection
Joint capsule
incise the joint capsule between the radial nerve laterally and the brachialis muscle medially
Proximal radius
expose proximal radius by supinating the forearm to bring the supinator muscle anteriorly.
Incise the muscle origin down to bone, lateral to the insertion of the biceps tendon
Extension
Extension
Proximal
extends into the anterolateral approach to the forearm developing the plane between the brachialis and the triceps muscles
Distal
extends to the anterior approach to the radius between the planes of the brachioradialis and pronator teres muscles proximally, and the brachioradialis and flexor carpi radialis (median nerve) muscles distally.
Dangers
Lateral cutaneous nerve of the forearm
Radial nerve
PIN
vulnerable as it winds around the neck of the radius within the substance of the supinator muscle. Incise the supinator muscle at its origin with forearm supinated to protect the nerve.
Recurrent branch of the radial artery
must be ligated to mobilize the brachioradialis
