Stiffness is a relatively common elbow problem, especially after any type of trauma or surgery to the elbow in an adult. The key to preventing stiffness after a broken elbow or surgery is to start early motion.
There are many causes of elbow stiffness. The causes can be located in any of the following anatomical compartments:
- Within the Joint
- Loose cartilage or bone, scar tissue (adhesions), arthritis, irregular joint surfaces
- In the Joint Capsule
- Scarring of the joint capsule
- Outside the Joint
- Muscle Scarring and shortening, bone formation in the muscles (Heterotopic Ossification)
If an elbow is stiff after an injury or surgery, it is important to remember that the motion will continue to improve for up to 1 year after the initial insult. Physiotherapy and elbow splinting can help achieve this improvement:
- Physiotherapy: Aims at improving the range of motion in the elbow with end range stretches in both an active and passive manner
- Splinting: Turnbuckle splinting involves applying a elbow brace which can be set to apply a constant force to the elbow over a prolonged period which aims at stretching the tissues and thereby improving motion. Pictured is the Aircast Mayo elbow brace, which can be ordered from the OPC website
If a significant amount of time has passed and these measures are not improving the elbow motion, and the patient is functionally restricted in their activities of daily living because of the elbow stiffness, then consideration may be given to surgically releasing the elbow joint to achieve an improvement in the motion. The surgery may be done by either open or arthroscopic (minimally invasive) means, with the decision depending on what each elbow has had done previously and its current status.
In general, surgery will improve motion. It will not restore motion to normal. The amount of improvement is usually half of what was lacking e.g if an elbow is lacking 60 degrees of extension, then after surgery it will only be lacking 30 degrees of surgery.