Anterolateral approach to the ellbow

Proximally bwtween:

brachialis (musculocutaneous n.)

brachioradialis (radial nerve)

Distally between

brachioradialis (radial nerve)

pronator teres (median nerve)

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

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

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

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.

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