The Stiff Elbow is defined as the restriction of movement of the elbow to its full range of motion.
Normal movement range
| Flexion | 0-140° |
| Hyperextension | 0-10° |
| Supination | 85° |
| Pronation | 70°-80° |
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
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
- Articular
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
- Significant alternation of articular contour
- Loss of cartilage > 50 %
- When the release of one or bone collateral ligaments
- Motor deficiency or spasticity
Arthroplasty options:-
See also: Myositis Ossificans of the Elbow
See also: Panner’s Disease of Elbow
