Our Summary

This research paper is about a comparison between two surgical treatments for elbow stiffness, which can severely limit daily activities. The treatments are open arthrolysis (a more invasive surgery where the joint is opened) and arthroscopic arthrolysis (a less invasive surgery using a camera and small tools).

The researchers looked at studies published between 2013 and 2021, and found 27 studies that included a total of 1666 patients. 63.6% of these patients had the open surgery, while 36.4% had the arthroscopic surgery.

The results showed that both types of surgery produced good results in terms of improving function in the elbow. However, the arthroscopic surgery had a slightly better success rate (91.8% compared to 88.8% for the open surgery) and fewer complications and need for follow-up surgeries.

The conclusion is that while both surgeries can effectively treat elbow stiffness, the arthroscopic procedure may be preferred because it has fewer complications and less need for further surgeries. The study also suggests that more research is needed on the role of forearm rotation and the use of a hinged external fixator (a device to stabilize the joint) in these surgeries.

FAQs

  1. What are the two surgical treatments for elbow stiffness discussed in the research paper?
  2. What were the success rates for open arthrolysis and arthroscopic arthrolysis?
  3. Why might arthroscopic arthrolysis be preferred over open arthrolysis according to the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about elbow surgery is to follow the post-operative instructions carefully, including attending physical therapy sessions as recommended to regain strength and range of motion in the elbow. It is important to communicate any concerns or changes in symptoms to your healthcare provider to ensure a successful recovery.

Suitable For

Patients who are typically recommended elbow surgery for stiffness and limited range of motion include those with conditions such as:

  1. Osteoarthritis: Elbow arthritis can cause stiffness and pain in the joint, leading to difficulty in performing daily activities.

  2. Rheumatoid arthritis: This autoimmune condition can cause inflammation and stiffness in the elbow joint.

  3. Trauma: Injuries such as fractures or dislocations can result in stiffness in the elbow joint, which may require surgical intervention to restore function.

  4. Contractures: Contractures are abnormal shortening of muscles or tendons, which can lead to elbow stiffness and limited range of motion.

  5. Tendonitis: Inflammation of the tendons around the elbow joint can cause stiffness and pain, requiring surgical treatment to improve function.

  6. Nerve compression: Nerve compression in the elbow region can result in weakness and limited mobility, which may necessitate surgical intervention to release the nerve.

Overall, patients who have tried conservative treatments such as physical therapy and medication but have not seen significant improvement in their elbow stiffness may be recommended for surgical intervention to address the underlying issue and improve their quality of life.

Timeline

Before surgery:

  1. Patient experiences pain, limited range of motion, and difficulty performing daily activities due to elbow stiffness.
  2. Patient undergoes physical examination, imaging tests (such as X-rays or MRI), and consultation with a surgeon to determine the best course of treatment.
  3. Patient and surgeon discuss the risks and benefits of open arthrolysis and arthroscopic arthrolysis surgeries, and make a decision on the type of surgery to proceed with.

After surgery:

  1. Patient undergoes pre-operative preparations, such as fasting and anesthesia administration.
  2. Surgery is performed, either open arthrolysis or arthroscopic arthrolysis, to release scar tissue and improve joint movement.
  3. Patient wakes up from anesthesia in the recovery room and is monitored for any complications.
  4. Patient may experience pain, swelling, and stiffness in the elbow post-surgery and will be prescribed pain medication and physical therapy to aid in recovery.
  5. Patient attends follow-up appointments with the surgeon to monitor progress and make any necessary adjustments to the treatment plan.
  6. Patient gradually resumes normal activities as the elbow heals and range of motion improves.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with both open and arthroscopic elbow surgery?
  2. What is the expected recovery time and rehabilitation process for each type of surgery?
  3. How long will I need to stay in the hospital after the surgery?
  4. Will I need physical therapy following the surgery, and if so, for how long?
  5. Are there any restrictions or limitations on activities I should be aware of after the surgery?
  6. What is the success rate of each type of surgery in terms of improving function in the elbow?
  7. How long do the results of the surgery typically last?
  8. Are there any alternative treatments or therapies that could be considered instead of surgery?
  9. What is the experience and success rate of the surgeon with performing these types of surgeries?
  10. Are there any specific factors about my individual case that may influence the choice between open and arthroscopic surgery for elbow stiffness?

Reference

Authors: Lanzerath F, Wegmann K, Hackl M, Uschok S, Ott N, Müller LP, Leschinger T. Journal: Arch Orthop Trauma Surg. 2023 May;143(5):2383-2393. doi: 10.1007/s00402-022-04442-0. Epub 2022 Apr 28. PMID: 35482109