Valgus Extension Overload: Arthroscopic Decompression in the Supine-Suspended Position  Patrick Barousse, M.D., M.P.H., Michael Saper, D.O., Karim Meijer, M.D., Charles Roth, M.D., James R. Andrews, M.D.  Arthroscopy Techniques  Volume 5, Issue 4, Pages e845-e850 (August 2016) DOI: 10.1016/j.eats.2016.04.005 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A, B) Our preferred patient positioning for elbow arthroscopy: the supine-suspended position. A right elbow is shown with the operative arm placed in balanced suspension with 5 to 8 lb of weight. Arthroscopy Techniques 2016 5, e845-e850DOI: (10.1016/j.eats.2016.04.005) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 The elbow is palpated to identify important anatomic landmarks. A marking pen can be used to outline the olecranon, medial epicondyle, ulnar nerve, radial head, and capitellum. The relations of the medial portals to the major neurovascular structures in the area are shown. Arthroscopy Techniques 2016 5, e845-e850DOI: (10.1016/j.eats.2016.04.005) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Establishing the anterior-lateral portal (right elbow): A blunt trocar is introduced over the lateral condylar ridge of the humerus into the elbow joint. Arthroscopy Techniques 2016 5, e845-e850DOI: (10.1016/j.eats.2016.04.005) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 With the arm near full extension, the straight posterior portal is created under direct visualization while viewing from the posterior-lateral portal (right elbow). This portal is typically about 90° from the posterior-lateral portal to avoid traffic with the instrumentation. Arthroscopy Techniques 2016 5, e845-e850DOI: (10.1016/j.eats.2016.04.005) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Arthroscopic decompression for valgus extension overload viewed from the posterior-lateral portal (right elbow) with the patient in the supine-suspended position. (A, B) Osteophyte decompression is begun with a standard arthroscopic shaver and burr. (C) An osteotome can be used to loosen the fibrous tissue between the spur and olecranon tip. (D) After completion of the procedure. Arthroscopy Techniques 2016 5, e845-e850DOI: (10.1016/j.eats.2016.04.005) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 The posterior-medial elbow viewed arthroscopically from the posterolateral portal (right elbow) with the patient in the supine-suspended position. The surgeon should always be cognizant of the ulnar nerve (n) and posterior band of the ulnar collateral ligament (UCL) when debriding the posterior-medial olecranon. Arthroscopy Techniques 2016 5, e845-e850DOI: (10.1016/j.eats.2016.04.005) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions