Elbow Stiffness

What is it?

The elbow is made up of three bones – the upper parts of the two forearm bones (‘radius’ and ‘ulna’) and the lower part of the arm bone - the ‘humerus’. The joint between the upper part of the ulna and humerus (ulno-humeral joint), is mainly responsible for bending and straightening the elbow. The joint between the upper part of the radius (radial head) and humerus, and the joints between the radius and ulna, are involved in rotating the forearm.
Normally one can bend the elbow from a fully straight position to about 145 degrees. The elbow joint is however notorious for loosing movement and becoming stiff after any pathology. This results in awkward elbow movement and one is unable to fully straighten or bend one’s elbow.

What is its cause?

There are many reasons for elbow stiffness. The most common cause is injury. Injuries such as elbow fracture, dislocation, or a soft tissue injury. The other most common cause of block in movement is because of bony spurs forming, due to elbow arthritis. Examples of soft tissue problems that may result in loss of joint movement are skin contractures (burns), tendon inflammations (like tennis elbow), and capsular contracture after a soft tissue injury.

Posterior impingement of the elbow is another cause of elbow stiffness. This condition is seen after repetitive activity that requires forced elbow extension (racquet sports). The repetitive activity causes inflammation at the back of the elbow, resulting in loss of elbow extension. Other unusual conditions are ‘Panner’s disease’ (were a small portion of the bone dies for unknown reasons – ‘avascular necrosis’), ‘synovial chondromatosis’ (x-ray below), ‘heterotrophic ossification’ etc.

Elbow Stiffness

What are the symptoms and how is the condition diagnosed?

The complaint is of being unable to fully straighten or bend the elbow. The ability to fully rotate the forearm may also have been lost. The patient may also complain of pain or discomfort in the elbow depending on the pathology.

Will further tests or investigations be needed?

An x-ray of the elbow is usually recommended as a primary investigation. Sometimes other investigations like an MR scan may be advised, so as to exclude other pathology.

What is the treatment?

Treatment is recommended if there is a loss of a functional range of movement. Most people are able to cope with the loss of the ability to straighten the elbow by 20-30 degrees. Loss of the ability to bend the elbow causes more functional problems. Treatment is directed at the original pathology.

  • Physiotherapy and serial splinting is the initial line of treatment for elbow stiffness after a soft tissue injury. It is also the best treatment for children.
  • Arthroscopic (keyhole) surgery is a relatively small operation during which the tight and contracted elbow capsule is released. About 2-3 small incisions of 5mm each are needed. The procedure is usually practiced for stiffness in early arthritis.
  • Open surgical release is practiced for severe elbow stiffness. The surgery is aimed to address the original pathology (elbow arthritis, stiffness following elbow fractures).

What happens if it is not treated?

It is possible that the post-injury stiffness may not deteriorate, and that the patient becomes used to the elbow stiffness. In conditions like arthritis it is likely that the stiffness will progress further as the arthritis advances.

What is the success of surgical treatment?

The outcome will vary depending on the cause of the stiffness.

What are the complications of surgical treatment?

  • Infection of the wound is possible and can usually be successfully treated with antibiotics.
  • Damage to the nerve or blood vessels is possible, but very rare.
  • The operation may fail to improve flexibility, and there is a very small possibility that the stiffness may worsen.
  • Any surgical intervention has the risk of developing complications that are unpredicted. These complications may have the potential to leave the patient worse than before surgery.

Is there anything I can do to improve the outcome?

Keep the wounds dry and clean until they have healed.
It is important to remember that the operation was carried out to increase movement. After the operation, it is important to discard the sling as soon as possible and carry out the prescribed exercises regularly, both during the physiotherapy sessions and at home.

When can I do various activities?

Return to work depends on many factors including the nature of the operation, the type of the job and hand dominance. Generally you will be able to return to a desk job within 2-3 weeks of the operation and perform reasonable tasks with the limb by that time. Manual work should be avoided for 8-10 weeks.

Driving should be possible within 7-10 days of the operation. Before driving, do check that you can manage all controls and start with short journeys.