Midline Incision

The midline posterior elbow incision. An anatomical appraisal

Dowdy PA, Bain GI, King GJ, Patterson SD

Musculoskeletal Research Laboratory, St Joseph's Health Centre, London, Ontario, Canada.

The formation of a painful neuroma after operations on the medial or lateral sides of the elbow is a common problem.

Our aim was to determine the relationship of the cutaneous nerves to the three usual skin incisions around the elbow.

In 18 freshly frozen cadaver arms we made three standard 16 cm incisions in the skin medially, laterally, and posteriorly and explored them using loupe magnification. The number of nerves crossing each incision was determined by gross observation and their diameter measured by electronic microcallipers. In ten arms, biopsies of the nerves in each incision were sent for histological examination. We found significantly more cutaneous nerves crossing the medial and lateral incisions than the posterior. The diameter of the nerves crossing the posterior incision was significantly smaller than those crossing the lateral incision.

Cutaneous nerves are at considerable risk of injury when medial or lateral incisions are used to approach the elbow, but the posterior approach carries less hazard. The routine use of the posterior incision may reduce the incidence of symptomatic paraesthesia and the formation of a painful neuroma after operation.

J Bone Joint Surg Br 1995 Sep;77(5):696-9