Treatment - How can I help

Stiff Elbow

Other popular names

None

Who does it affect?

Anyone

Why does it happen?

Factors that cause stiffness are divided into those that are within the elbow joint itself (intrinsic) and those in the tissues around the joint, such as the muscles and tendons (extrinsic).  Intrinsic causes may be due to post-traumatic osteoarthritis, primary osteoarthritis, rheumatoid arthritis, joint infection or malunions.  Extrinsic causes may be due to burns, heterotopic ossification or congenital issues such as arthrogryposis or congenital dislocation of the radial head.

The commonest cause of stiffness is after trauma and injury. In fact, some stiffness after an elbow injury is very common.  Usually this improves, but sometimes it may not.  The amount of stiffness is directly related to the degree of initial trauma and the degree of involvement of the joint surfaces is most important. The length of immobilisation after injury also leads to more long-term stiffness.

Symptoms

The elbow joint is a type of hinge joint. It bends (flexion) and straightens (extension), as well as rotating to position your palm up or down. The normal range of flexion and extension is from 0 to 145 degrees, although the range of motion that we work within for daily activities is only from 30 to 130 degrees. This means that for most people a bit of loss of motion does not cause problems with function. However, with a reduction of extension greater than 30 degrees and or a flexion less than 130 degrees most people will complain of loss of function. Loss of extension is usually less disabling than loss of same degree of flexion.

Diagnosis

Investigations are normally not necessary as the condition is well known and easy to identify.  Ultrasound or MRI scans may be used to examine tissue damage.

Non-surgical treatment

The aim is to give you a pain-free, functional and stable elbow. This means 30-130 degrees flexion and 100 degrees of rotation.  Physiotherapy is often used and involves passive motion exercises and stretching (not too aggressive) and active exercises.  This may be supplemented by splinting.
Surgery will be offered if physiotherapy is not effective.

Surgical treatment

Surgery is carried out as a day case procedure usually either under local or general anaesthetic and takes about 15-30 minutes.
This may be performed arthroscopically (key-hole) or open and will depend upon your condition.
Arthroscopic release is ideal for stiffness due to arthritis and when there has been no previous surgery. However, if there has been a previous internal fixation and there are extrinsic causes for the stiffness open surgery is required.

Post-surgery rehabilitation

You can go home soon after the operation.  The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The arm should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers and elbow from day 1. The dressing will be removed soon after your operation.  The wound is cleaned and redressed with a simple dressing.  Avoid forced gripping or lifting heavy objects for 2-3 weeks.  The sutures are removed at about 10 days.  You should notice an improvement in symptoms within a few weeks but the final result may take some 3-6 months.
Return to normal routine

Keep the wound dry until the stitches are out at 10 days.

Return to driving:

The hand needs to have full control of the steering wheel and left hand the gear stick.  You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.

Return to work:

Everyone has different work environments.  Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament.  You will be given advice on your own particular situation.

Risks

Overall over 95% are happy with the result. However complications can occur.

General risks (less than 1% each):

Infection
Neuroma (nerve pain)
Numbness
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any elbow surgery from a minor procedure to a complex reconstruction).

Specific risks:

Failure to completely resolve the symptoms (approximately 1%) - this may be due to failure to completely release the area. This is rare, but may be released again.

 

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