June 20, 2024

The Stiff Elbow is defined as the restriction of movement of the elbow to its full range of motion.

Normal movement range

Flexion0-140°
Hyperextension0-10°
Supination85°
Pronation70°-80°
Movements

Functional range

100 ° of flexion

30°-130° – the arc of motion

100° of rotation

50° of pronation and 50° of supination

Classification of The Stiff Elbow

Classification of The Stiff Elbow

Management of The Stiff Elbow

The management outline of the stiff elbow is described in detail below:

Acute cases

  • OR IF
  • Continuous passive motion
  • A splint (dynamic and static)

Sub-acute cases (< 6 months)

  • Splints
  • anti-inflammatory drugs
  • Close follow up

Chronic cases

  • Extrinsic
    • Release
  • Intrinsic
    • Articular
      • Soft tissue release
      • Distraction arthroplasty
      • Elbow arthroplasty if (> 50%) cartilage destroyed
    • Impingement
      • Coronoid/ Olecranon excision of bony stop

Column Procedure

  • Posterolateral incision/ Kocher incision
  • Separate extensor tendons from joint capsule and LCL
  • Expose anterior capsule –> Release
  • If flexion is limited and extension not complete:- Release of posterior capsule + excision of olecranon osteophytes and coronoid osteophytes

Bhattacharya Procedure

Elbow arthro-lysis procedure

( Loosing of adhesion in an ankylosed joint to restore mobility)

Includes

  • Removal of capsular
  • Mobilizing brachialis and triceps from the lower humerus
  • Restoration of trochlear pulley
  • Minimal removal of the bone block without excising articular surface

Post-operative course

  • Instill 25 mg hydrocortisone acetate in joint with 2 -5 cc of hylase
  • Compression bandages with the splint in full extension
  • Second dose of hydrocortisone with 2-4 cc of lignocaine on 7th -10th day

Contraindication of arthrolysis/ Soft tissue release

  1. Significant alternation of articular contour
  2. Loss of cartilage > 50 %
  3. When the release of one or bone collateral ligaments
  4. Motor deficiency or spasticity

Arthroplasty options:-

Arthroplasty option for stiff elbow
Arthroplasty Option

See also: Myositis Ossificans of the Elbow

See also: Panner’s Disease of Elbow