Elbow Stiffness

The cause of a stiff elbow is either at the bony level or the collagen capsule/ligament level or both.

Pathology

The cause of a stiff elbow is either at the bony level or the collagen capsule/ligament level or both.

Common Causes of Stiff Elbow

  • Major trauma secondary to a fracture or fracture-dislocation
  • Repetitive microtrauma

Heterotopic Ossification

When elbow trauma is associated with a close head injury, a buildup of abnormal bone can develop in locations where it is not normally found. This is called heterotopic ossification.

If the bone develops in muscle, it is called myositis ossificans. When bone develops in the elbow, it can bind the humerus to the radius or ulna. This affects flexion, extension and forearm rotation. To make the diagnosis, a physical exam and plain x-rays are all that is required prior to proceeding with surgery.

Treatment

The treatment of a stiff elbow depends on the cause of the stiff joint. When the problem is the joint capsule and only minor spurs are present in the elbow, the contracture can be removed arthroscopically through small incisions.

If there is heterotopic bone, the procedure involves an open incision and within 24 hours of surgery, it is common to use a small dose of radiation to limit the recurrence rate of the heterotopic bone. Aggressive therapy to maintain the motion obtained during surgery is critical to ensure a lasting result. The use of splints to assist in the maintenance of the motion is also common.

Arthroscopic soft tissue procedures are at maximum improvement within 2 months but open procedures involving bone removal may take as much as 4-6 months to reach maximum medical improvement.