Medial approach to the ellbow

Proximally between

brachialis (musculocutaneous nerve)

triceps (radial nerve)

Distally between

brachialis (musculocutaneous

pronator teres (median nerve)

Positioning & Preparation

Position

supine, arm supported by an arm board over the patient

Superficial dissection

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

perform osteotomy of the medial epicondyle and reflect distally

develop brachialis and triceps interval

Deep dissection

incise capsule and medial collateral ligament

Extension

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

distal

limited by the branches of the median nerve

Ulnar nerve (as above)

Median nerve

aggressive traction on the osteotomy fragment can cause a traction injury to the median and anterior interosseous nerves

Incision

curved incision 8 to 10 cm long on the medial aspect of the elbow,

centered over the medial epicondyle