Cadaveric study on feasibility of elbow joint denervation through a single posterior incision.

Background: Treatment options for painful elbow osteoarthritis are limited. When a conservative therapy and débridement fail, total elbow arthroplasty remains the only salvage procedure. However, it is costly, highly invasive, and unsuitable for younger, active patients because of strict activity restrictions and limited prosthesis longevity. While denervation is a well-established intervention for hand and wrist osteoarthritis, its application in the elbow remains underexplored. This cadaveric study assesses the accessibility of elbow joint articular branches (ABs) through a single posterior incision. Methods: Ten fresh-frozen upper extremities were dissected via a standardized 20-cm posterior midline incision. Eight nerves were targeted: the medial antebrachial cutaneous nerve, ulnar, ulnar collateral, median, posterior antebrachial cutaneous nerve, radial, radial collateral, and musculocutaneous nerve. For each nerve, accessibility, number of ABs, and distance from the corresponding epicondyle were recorded. Results: All 8 nerves and their ABs were successfully accessed in all 10 specimens. Medial nerves include the medial antebrachial cutaneous nerve (mean 1.3 ABs; 4.8 cm from medial epicondyle), ulnar nerve (1.3 ABs; 1.6 cm), ulnar collateral nerve (7.4 cm), and median nerve (1.2 ABs; 2.0 cm). Lateral nerves include the posterior antebrachial cutaneous nerve (1.8 cm from lateral epicondyle), radial nerve (1.4 ABs; 6.4 cm), radial collateral nerve (7.0 cm), and musculocutaneous nerve (1.0 AB; 1.2 cm). Conclusion: A single-incision posterior approach provides consistent access to all key nerves innervating the elbow joint. These findings demonstrate the anatomic feasibility of elbow denervation, while preserving the option for a future reconstructive surgery through the same incision.