Management of the Post-traumatic Stiff Elbow

Abstract

Restriction of elbow motion after trauma is a well‐recognized problem. Most cases improve with time and use, although significant stiffness may persist and interfere with function. Over the last 20 years, surgical procedures have been reported that can safely improve the range of motion in most patients. A wide variety of different operative procedures and postoperative regimes have been described, with comparable results. Surgical techniques range from arthroscopic procedures, through increasingly extensive open releases, up to those requiring a dynamic external fixator to provide stability. Postoperative passive stretching with manipulation or splinting is often advocated, although evidence of effectiveness is lacking. We provide an overview of the current literature, and propose a new surgical guide to aid with the management of stiff elbows.

Conservative management of the post-traumatic stiff elbow: a physiotherapist’s perspective

“…2 This deficit in range is usually well tolerated; however, in contrast, loss of flexion significantly affects function because the hand is unable to reach the head and mouth. 2 The deficit in flexion cannot be overcome with compensation at other joints, with up to 12% of all elbow fractures and dislocations developing a limitation in flexion that requires surgical intervention. 5 This review focuses on the assessment and physiotherapy management of post-traumatic elbow stiffness and presents a guide for the conservative management of this condition…”

“…This classification system offers little in terms of the management or prognosis of these conditions and therefore is of limited value when assessing an individual's injury. 2…”

“…It is important to qualify the nature of an individual's pain, including its quality and behaviour in different scenarios and over a 24-hour period. 2 Frequency and dosage of analgesia and other medications may help the therapist establish the severity of a patient's pain. Developments in our understanding of pain emphasise the importance of considering peripheral, central, autonomic and psychosocial influences upon a patient's presentation, which will have a direct impact on rehabilitation options chosen.…”

“…Any deformity, muscle wastage, previous scars, prominent metalwork, along with oedema, colour changes and trophic changes in the elbow, forearm and hand, should be noted. 2…”

“…Unfortunately, stiffness is a common clinical problem following elbow trauma, 2 as a result of the rigidity of the ulnohumeral joint, the presence of three joints in one synovial space, and the close relationship between the joint capsule, the intracapusular ligaments and the surrounding musculature. In particular, the brachialis muscle overlays the elbow joint capsule anteriorally and is a primary site for heterotopic ossification.…”