Our Summary

This research paper discusses the issue of elbow stiffness, a condition that can severely limit the use of the affected arm and often results from trauma or injury. Treatment may be necessary if the range of motion in the elbow is less than 100 degrees, but this should be determined on a case-by-case basis.

Fixing a stiff elbow can be difficult, time-consuming, and expensive. The first choice of treatment is typically non-surgical, with surgery only considered if the stiffness remains after non-surgical treatment. Unfortunately, stiffness can return after surgical treatment.

The paper then provides a detailed look at the structure of the elbow, the best ways to perform arthroscopic (a less invasive surgery using a camera to see inside the joint) and open contracture release (a more invasive surgery to release the stiff joint), and methods to rehabilitate the elbow after surgery to reduce the risk of stiffness coming back. The authors stress the importance of personalizing treatment plans to fit each patient’s unique needs and expectations.

FAQs

  1. What is the primary management option for elbow stiffness?
  2. What factors should be considered when deciding if surgical intervention is necessary for elbow stiffness?
  3. What methods are used postoperatively to reduce the risk of recurrent stiffness after elbow surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about elbow surgery is to follow the prescribed postoperative rehabilitation plan diligently. This may include physical therapy exercises to improve range of motion and strength in the elbow. It is important to be patient and consistent with these exercises to achieve the best possible outcome after surgery. Additionally, it is important to communicate any concerns or difficulties with the healthcare team to ensure proper care and support throughout the recovery process.

Suitable For

Patients who are typically recommended elbow surgery include those with:

  • Severe elbow stiffness with a motion arc less than 100°
  • Refractory stiffness that has not improved with nonsurgical treatments
  • Traumatic injuries leading to restricted range of motion
  • Chronic conditions such as arthritis or contractures causing limited functionality
  • Patients who have exhausted all other treatment options and continue to experience significant limitations in daily activities due to elbow stiffness

It is important for patients to work closely with their healthcare provider to determine the most appropriate treatment plan based on their individual needs and functional expectations. Surgery should be considered as a last resort after conservative treatments have been attempted and failed to improve elbow stiffness.

Timeline

Before elbow surgery:

  1. Patient experiences trauma or injury to the elbow, resulting in stiffness and limited functionality.
  2. Patient undergoes evaluation by a healthcare provider to determine the severity of the stiffness and the need for intervention.
  3. Nonsurgical treatment options, such as physical therapy, are attempted to improve joint motion.
  4. If nonsurgical treatment is unsuccessful and the motion arc is less than 100°, surgical intervention may be recommended.

After elbow surgery:

  1. Patient undergoes elbow contracture release surgery to restore joint motion.
  2. Postoperative rehabilitation begins immediately to prevent recurrent stiffness and improve range of motion.
  3. Patient follows a structured rehabilitation program, including exercises, stretches, and possibly splinting or bracing.
  4. Patient gradually regains range of motion and functional use of the affected arm over several weeks to months.
  5. Follow-up appointments with the healthcare provider are scheduled to monitor progress and address any concerns.
  6. Patient may experience occasional setbacks or complications, such as recurrent stiffness, which may require additional treatment or interventions.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with elbow surgery?

  2. What is the success rate of elbow surgery for treating stiffness?

  3. What is the expected recovery time and rehabilitation process after elbow surgery?

  4. Will I need physical therapy after surgery, and if so, for how long?

  5. What are the long-term outcomes and potential limitations of elbow surgery?

  6. Are there alternative treatments or non-surgical options that I should consider before opting for surgery?

  7. How many elbow surgeries have you performed, and what is your experience with treating elbow stiffness?

  8. Can you provide me with information about the specific surgical technique you plan to use for my case?

  9. What are the potential factors that could increase the risk of recurrent stiffness after surgery, and how can I minimize these risks?

  10. What are the expected benefits and improvements I can expect after undergoing elbow surgery for stiffness?

Reference

Authors: Kim HM, Morrey ME, Steinmann S, Barco R. Journal: Instr Course Lect. 2024;73:625-637. PMID: 38090929