Post-traumatic elbow stiffness: Pathogenesis and current treatments

Abstract

Post-traumatic elbow stiffness is a major cause of functional impairment after elbow trauma. A stiff elbow limits patients’ ability to position their hand in space for optimal use of their upper extremities, and as such, is a frequent indication for reoperation. This article reviews current concepts on the pathogenesis of post-traumatic elbow stiffness. Current nonoperative treatment options include therapy, bracing, and manipulation under anesthesia, while operative treatment options include arthroscopic and open arthrolysis. The pros and cons of various treatment options are discussed, with a focus on the evidence supporting their use, the expected functional gains, and associated complications. Future directions in post-traumatic elbow stiffness are highlighted.

Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems

“…Arthroscopic elbow release has the advantage of decreased soft tissue trauma, improved joint visualization, and more rapid functional recovery. Although there is potential risk of nerve injury, arthroscopic arthrolysis is generally safe and effective [15][16][17][18] . It is especially suitable for elbow stiffness without bony problems, which include intraarticular malunion or nonunion and HO formation around the elbow.…”

“…Anterior capsule contracture leads to flexion contracture, and posterior capsule contracture leads to elbow stiffness in extension. Open or arthroscopic capsulectomy have been well described for treating elbow stiffness [7][8][9][10][11][12][13][14][15][16][17][18] . It becomes very challenging when there is adhesion between the capsule and the joint.…”

“…The treatment of elbow stiffness varies from nonsurgical rehabilitation to surgical managment. There are various techniques if surgical treatment is indicated, including arthroscopic and open release and different types of arthroplasty procedure [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Open procedures for treating posttraumatic elbow stiffness have been well described in the literature.…”

“…The arthroscopic release approach for treating a stiff elbow has developed over the past few decades [16][17][18] . This technique has the advantages of less soft tissue trauma, better visualization, and more rapid functional recovery.…”

The stiff elbow: Current concepts

“… 16 In the future, gene therapy may play an important role in the interruption of the inflammatory cycle, which is the basis of elbow stiffness, by altering the expression profile of cytokines. 24 The role of botulinum toxin in the prevention of post-traumatic rigid elbow has recently been analysed. Intraoperative injection of botulinum toxin A into the elbow flexors leads to an increase in postoperative ROM and joint function in patients undergoing surgery for fractures or fracture-dislocations.…”