The stiff elbow: Current concepts

Giulia Masci, Gianpiero Cazzato, Giuseppe Milano, Gianluca Ciolli, Giuseppe Malerba, Carlo Perisano, Tommaso Greco, Palmacci Osvaldo, Giulio Maccauro, Francesco Liuzza, Giulia Masci, Gianpiero Cazzato, Giuseppe Milano, Gianluca Ciolli, Giuseppe Malerba, Carlo Perisano, Tommaso Greco, Palmacci Osvaldo, Giulio Maccauro, Francesco Liuzza

Abstract

Elbow stiffness is defined as any loss of movement that is greater than 30° in extension and less than 120° in flexion. Causes of elbow stiffness can be classified as traumatic or atraumatic and as congenital or acquired. Any alteration affecting the stability elements of the elbow can lead to a reduction in the arc of movement. The classification is based on the specific structures involved (Kay's classification), anatomical location (Morrey's classification), or on the degree of severity of rigidity (Vidal's classification). Diagnosis is the result of a combination of medical history, physical examination (evaluating both active and passive movements), and imaging. The loss of soft tissue elasticity could be the result of bleeding, edema, granulation tissue formation, and fibrosis. Preventive measures include immobilization in extension, use of post-surgical drain, elastic compression bandage and continuous passive motion. Conservative treatment is used when elbow stiffness has been present for less than six months and consists of the use of serial casts, static or dynamic splints, CPM, physical therapy, manipulations and functional re-education. If conservative treatment fails or is not indicated, surgery is performed. Extrinsic rigidity cases are usually managed with an open or arthroscopic release, while those that are due to intrinsic causes can be managed with arthroplasties. The elbow is a joint that is particularly prone to developing stiffness due to its anatomical and biomechanical complexity, therefore the treatment of this pathology represents a challenge for the physiotherapist and the surgeon alike.

Keywords: Stiff elbow; elbow; elbow contracture; post-traumatic stiffness.

Conflict of interest statement

Conflict of interest: The authors declare no potential conflict of interest.

©Copyright: the Author(s).

Figures

Figure 1.
Figure 1.
ROM in flexion reduction secondary to right olecranon fracture.
Figure 2.
Figure 2.
X-ray views (AP) showing intraarticular bone fragments.
Figure 3.
Figure 3.
X-ray views (LL) showing intraarticular bone fragments.
Figure 4.
Figure 4.
Functional re-education to pronation-supination.
Figure 5.
Figure 5.
Medial access to isolate ulnar nerve.

References

    1. Adolfsson L. Post-traumatic stiff elbow. EFORT Open Rev 2018;3:210-6.
    1. Nandi S, Maschke S, Evans PJ, Lawton JN. The stiff elbow. Hand NY N 2009;4:368-79.
    1. Bedeschi Celli. Il gomito. Patologia traumatica. 1990th ed. Aulo Gaggi.
    1. Hildebrand KA. Posttraumatic elbow joint contractures: defining pathologic capsular mechanisms and potential future treatment paradigms. J Hand Surg 2013;38:2227-33.
    1. Kodde IF, van Rijn J, van den Bekerom MPJ, Eygendaal D. Surgical treatment of post-traumatic elbow stiffness: a systematic review. J Shoulder Elbow Surg 2013;22:574-80.
    1. Altissimi Catalano. La patologia non traumatica del gomito. 1998th ed. Mattioli.
    1. Morrey BF. Le patologie del gomito. Diagnosi e trattamento. 2002nd ed. Verduci editore.
    1. Søjbjerg JO. The stiff elbow. Acta Orthop Scand. 1996;67:626-31.
    1. Evans PJ, Nandi S, Maschke S, et al. Prevention and treatment of elbow stiffness. J Hand Surg 2009;34:769-78.
    1. Wessel LE, Gu A, Richardson SS, et al. Elbow contracture following operative fixation of fractures about the elbow. JSES Open Access 2019;3:261-5.
    1. Tunalı O, Erşen A, Pehlivanoğlu T, et al. Evaluation of risk factors for stiffness after distal humerus plating. Int Orthop 2018;42:921-6.
    1. Cohen MS, Schimmel DR, Masuda K, et al. Structural and biochemical evaluation of the elbow capsule after trauma. J Shoulder Elbow Surg 2007;16:484-90.
    1. Filh GM, Galvão MV. POSTTRAUMATIC STIFFNESS OF THE ELBOW. Rev Bras Ortop 2010;45:347-54.
    1. Mellema JJ, Lindenhovius ALC, Jupiter JB. The posttraumatic stiff elbow: an update. Curr Rev Musculoskelet Med 2016;9:190-8.
    1. Everding NG, Maschke SD, Hoyen HA, Evans PJ. Prevention and treatment of elbow stiffness: a 5-year update. J Hand Surg 2013;38:2496-507.
    1. Lindenhovius ALC, Jupiter JB. The posttraumatic stiff elbow: a review of the literature. J Hand Surg 2007;32:1605-23.
    1. Morrey BF. The posttraumatic stiff elbow. Clin Orthop 2005;431:26-35.
    1. Sun Z, Fan C. Validation of the Liverpool Elbow Score for evaluation of elbow stiffness. BMC Musculoskelet Disord 2018;19:302.
    1. Charalambous CP, Morrey BF. Posttraumatic elbow stiffness. J Bone Joint Surg Am 2012;94:1428-37.
    1. Patiño JM, Saenz VP. Stiff Elbow (Elbow Contracture). StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020
    1. Robinson CG, Polster JM, Reddy CA, et al. Postoperative single-fraction radiation for prevention of heterotopic ossification of the elbow. Int J Radiat Oncol Biol Phys 2010;77:1493-9.
    1. Costopoulos CL, Abboud JA, Ramsey ML, et al. The use of indomethacin in the prevention of postoperative radioulnar synostosis after distal biceps repair. J Shoulder Elbow Surg 2017;26:295-8.
    1. Strauss JB, Wysocki RW, Shah A, et al. Radiation therapy for heterotopic ossification prophylaxis afer high-risk elbow surgery. Am J Orthop Belle Mead NJ 2011;40:400-5.
    1. Zhang D, Nazarian A, Rodriguez EK. Post-traumatic elbow stiffness: Pathogenesis and current treatments. Shoulder Elb 2020;12:38-45.
    1. Lindenhovius ALC, Doornberg JN, Brouwer KM, et al. A prospective randomized controlled trial of dynamic versus static progressive elbow splinting for posttraumatic elbow stiffness. J Bone Joint Surg Am 2012;94:694-700.
    1. Araghi A, Celli A, Adams R, Morrey B. The outcome of examination (manipulation) under anesthesia on the stiff elbow after surgical contracture release. J Shoulder Elbow Surg 2010;19:202-8.
    1. Ek ETH, Paul SK, Hotchkiss RN. Outcomes after operative treatment of elbow contractures in the pediatric and adolescent population. J Shoulder Elbow Surg 2016;25:2066-70.
    1. Basciani M, Intiso D. Botulinum toxin type-A and plaster cast treatment in children with upper brachial plexus palsy. Pediatr Rehabil 2006;9:165-70.
    1. Gauger EM, Rhee PC. Surgical Management of the Posttraumatic Stiff Elbow: A Step-Wise Algorithm for Open Osteocapsular Release. Tech Hand Up Extrem Surg 2018;22:127-33.
    1. Kruse KK, Papatheodorou LK, Weiser RW, Sotereanos DG. Release of the stiff elbow with mini-open technique. J Shoulder Elbow Surg 2016;25:355-61.
    1. Pederzini LA, Nicoletta F, Tosi M, et al. Elbow arthroscopy in stiff elbow. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2014;22:467-73.
    1. Zhou Y, Cai J-Y, Chen S, et al. Application of distal radius-positioned hinged external fixator in complete open release for severe elbow stiffness. J Shoulder Elbow Surg 2017;26:e44-51.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere