The use of the upright position of the patient, and a vertical incision for exposure of the brachial plexus, has been attended by no complications or serious hazards. The aid of skilled anaesthetists is acknowledged. The structures are visible and accessible; the operative field is steady; bleeding is controlled easily; and dissection is facilitated. By this technique it has been possible to explore a larger field from above, and division of the clavicle has seldom been necessary. Finally, and of importance, the operative area at shoulder level enables the surgeon to continue tedious dissection for some hours comfortably, and to escape postoperative postural complications in his own back.

1. A method of denervating the elbow joint, based upon observations on the articular branches of the main nerve trunks, is presented.

2. In a small group of cases with post-traumatic arthritis and osteoarthritis, relief of pain and restoration of painless movement has been gained.

3. There was recurrence of pain after six months in one patient with acute rheumatoid arthritis; in such cases denervation is not recommended until further study is completed.

4. Denervation must be as complete as possible and full exposure with stripping of nerve trunks is recommended. There have been no complications.

5. The results in this small series of cases are encouraging, but patients should be warned that there will be no significant increase in the range of movement, and that a normal joint is not to be expected.

6. Articular neurectomy is still on trial. If the limitations are recognised, the procedure may have a useful place in the relief of pain in the elbow joint.