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HAND
Published in: HAND 4/2009

01-12-2009 | Review Articles of topics

The Stiff Elbow

Authors: Sumon Nandi, Steven Maschke, Peter J. Evans, Jeffrey N. Lawton

Published in: HAND | Issue 4/2009

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Abstract

Elbow motion is essential for upper extremity function to position the hand in space. Unfortunately, the elbow joint is prone to stiffness following a multitude of traumatic and atraumatic etiologies. Elbow stiffness can be diagnosed with a complete history and physical exam, supplemented with appropriate imaging studies. The stiff elbow is challenging to treat, and thus, its prevention is of paramount importance. When this approach fails, non-operative followed by operative treatment modalities should be pursued. Upon initial presentation in those who have minimal contractures of 6-month duration or less, static and dynamic splinting, serial casting, continuous passive motion, occupational/physical therapy, and manipulation are non-operative treatment modalities that may be attempted. A stiff elbow that is refractory to non-operative management can be treated surgically, either arthroscopically or open, to eliminate soft tissue or bony blocks to motion. In the future, efforts to prevent and treat elbow stiffness may target the basic science mechanisms involved. Our purpose was to review the etiologies, classification, evaluation, prevention, operative, and non-operative treatment of the stiff elbow.
Literature
1.
2.
3.
4.
Bidner SM, Rubins IM, Desjardins JV, Zukor DJ, Goltzman D. Evidence for a humoral mechanism for enhanced osteogenesis after head injury. J Bone Jt Surg Am. 1990;72(8):1144–9.
5.
Bonutti PM, Windau JE, Ables BA, Miller BG. Static progressive stretch to reestablish elbow range of motion. Clin Orthop Relat Res. 1994;(303):128–34.
6.
7.
Cheung EV, Adams R, Morrey BF. Primary osteoarthritis of the elbow: current treatment options. J Am Acad Orthop Surg. 2008;16(2):77–87.PubMed
8.
Duke JB, Tessler RH, Dell PC. Manipulation of the stiff elbow with patient under anesthesia. J Hand Surg [Am]. 1991;16(1):19–24.
9.
10.
Evans PJ. Elbow interposition/distraction arthroplasty. In: Yamaguchi K, King GJW, McKee MD, O’Driscoll SWM, editors. Advanced reconstruction elbow. 1st ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007. p. 435.
11.
Failla JM, Amadio PC, Morrey BF, Beckenbaugh RD. Proximal radioulnar synostosis after repair of distal biceps brachii rupture by the two-incision technique. report of four cases. Clin Orthop Relat Res. 1990;(253):133–6.
12.
Figgie MP, Inglis AE, Mow CS, Figgie HE 3rd. Total elbow arthroplasty for complete ankylosis of the elbow. J Bone Jt Surg Am. 1989;71(4):513–20.
13.
Froimson AI, Anouchi YS, Seitz WH Jr, Winsberg DD. Ulnar nerve decompression with medial epicondylectomy for neuropathy at the elbow. Clin Orthop Relat Res. 1991;(265):200–6.
14.
Froimson AI, Morrey BF. Interposition arthroplasty of the elbow. In: Morrey BF, editor. Master techniques in orthopaedic surgery: the elbow. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 391.
15.
16.
17.
Garland DE, O’Hollaren RM. Fractures and dislocations about the elbow in the head-injured adult. Clin Orthop Relat Res. 1982;(168):38–41.
18.
Garland DE. A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res. 1991;(263):13–29.
19.
20.
21.
Green DP, McCoy H. Turnbuckle orthotic correction of elbow-flexion contractures after acute injuries. J Bone Jt Surg Am. 1979;61(7):1092–5.
22.
Heithoff SJ, Millender LH, Nalebuff EA, Petruska AJ Jr. Medial epicondylectomy for the treatment of ulnar nerve compression at the elbow. J Hand Surg [Am]. 1990;15(1):22–9.CrossRef
23.
Hildebrand KA, Zhang M, van Snellenberg W, King GJ, Hart DA. Myofibroblast numbers are elevated in human elbow capsules after trauma. Clin Orthop Relat Res. 2004;(419):189–97.
24.
25.
Hoffer MM, Brody G, Ferlic F. Excision of heterotopic ossification about elbows in patients with thermal injury. J Trauma. 1978;18(9):667–70.PubMed
26.
27.
Husband JB, Hastings H 2nd. The lateral approach for operative release of post-traumatic contracture of the elbow. J Bone Jt Surg Am. 1990;72(9):1353–8.
28.
Josefsson PO, Johnell O, Gentz CF. Long-term sequelae of simple dislocation of the elbow. J Bone Jt Surg Am. 1984;66(6):927–30.
29.
Jupiter JB, O’Driscoll SW, Cohen MS. The assessment and management of the stiff elbow. Instr Course Lect. 2003;52:93–111.PubMed
30.
Kamineni S, Maritz NG, Morrey BF. Proximal radial resection for posttraumatic radioulnar synostosis: a new technique to improve forearm rotation. J Bone Jt Surg Am. 2002;84-A(5):745–51.
31.
32.
Kasparyan NG, Hotchkiss RN. Dynamic skeletal fixation in the upper extremity. Hand Clin. 1997;13(4):643–63.PubMed
33.
Kelly EW, Morrey BF, O’Driscoll SW. Complications of elbow arthroscopy. J Bone Jt Surg Am. 2001;83-A(1):25–34.
34.
Kim P, Wolfe VM, McKean J, Jobin C, Strauch RJ, Rosenwasser MP. Intraoperative injection of botulinum toxin-A (Botox®) for prevention of post-traumatic elbow stiffness. Quebec: 2nd Combined Meeting of the American Orthopaedic Association and the Canadian Orthopaedic Association; 2008.
35.
36.
Laurencin CT, Schwartz JT Jr, Koris MJ. Compression of the ulnar nerve at the elbow in association with synovial cysts. Orthop Rev. 1994;23(1):62–5.PubMed
37.
38.
Mansat P, Morrey BF. The column procedure: a limited lateral approach for extrinsic contracture of the elbow. J Bone Jt Surg Am. 1998;80(11):1603–15.
39.
Mansat P, Morrey BF. Semiconstrained total elbow arthroplasty for ankylosed and stiff elbows. J Bone Jt Surg Am. 2000;82(9):1260–8.
40.
Manske PR, Johnston R, Pruitt DL, Strecker WB. Ulnar nerve decompression at the cubital tunnel. Clin Orthop Relat Res. 1992;(274):231–7.
41.
Masuko T, Kato H, Minami A, Inoue M, Hirayama T. Surgical treatment of acute elbow flexion contracture in patients with congenital proximal radioulnar synostosis. A report of two cases. J Bone Jt Surg Am. 2004;86-A(7):1528–33.
42.
McGowan AJ. The results of transposition of the ulnar nerve for traumatic ulnar neuritis. J Bone Jt Surg Br. 1950;32-B(3):293–301.
43.
McKee M, Jupiter J, Toh CL, Wilson L, Colton C, Karras KK. Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. methods and results in 13 adults. J Bone Jt Surg Br. 1994;76(4):614–21.
44.
McKee MD, Jupiter JB. A contemporary approach to the management of complex fractures of the distal humerus and their sequelae. Hand Clin. 1994;10(3):479–94.PubMed
45.
Mohan K. Myositis ossificans traumatica of the elbow. Int Surg. 1972;57(6):475–8.PubMed
46.
Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Jt Surg Am. 1981;63(6):872–7.
47.
Morrey BF. Post-traumatic contracture of the elbow. operative treatment, including distraction arthroplasty. J Bone Jt Surg Am. 1990;72(4):601–18.
48.
Morrey BF. Distraction arthroplasty. clinical applications. Clin Orthop Relat Res. 1993;(293):46–54.
49.
O’Driscoll SW, Horii E, Carmichael SW, Morrey BF. The cubital tunnel and ulnar neuropathy. J Bone Jt Surg Br. 1991;73(4):613–7.
50.
O’Driscoll SW, Giori NJ. Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev. 2000;37(2):179–88.PubMed
51.
O’Driscoll SW. Arthroscopic osteocapsular arthroplasty. In: Yamaguchi K, King GJW, McKee MD, O’Driscoll SWM, editors. Advanced reconstruction elbow. 1st ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007. p. 59.
52.
Page C, Backus SI, Lenhoff MW. Electromyographic activity in stiff and normal elbows during elbow flexion and extension. J Hand Ther. 2003;16(1):5–11.PubMedCrossRef
53.
54.
Pignatti G, Ferrari D, Tigani D, Scardovi M, Trentanti P, Trentani F, et al. The treatment of post-traumatic stiffness of the elbow. Chir Organi Mov. 2000;85(4):381–7.PubMed
55.
Rettig AC, Ebben JR. Anterior subcutaneous transfer of the ulnar nerve in the athlete. Am J Sports Med. 1993;21(6):836–9; discussion 839–40.CrossRefPubMed
56.
Ring D, Jupiter JB. Operative release of complete ankylosis of the elbow due to heterotopic bone in patients without severe injury of the central nervous system. J Bone Jt Surg Am. 2003;85-A(5):849–57.
57.
58.
Roberts JB, Pankratz DG. The surgical treatment of heterotopic ossification at the elbow following long-term coma. J Bone Jt Surg Am. 1979;61(5):760–3.
59.
60.
Robinson C, Lyons J, Evans PJ, Lawton JN, Graham T, Polster J, et al. Postoperative single fraction radiation for prevention of heterotopic ossification after elbow surgery. Int J Radiat Oncol Biol Phys. 2007;69(3):S545. doi:10.​1016/​j.​ijrobp.​2007.​07.​1794.
61.
Sazbon L, Najenson T, Tartakovsky M, Becker E, Grosswasser Z. Widespread periarticular new-bone formation in long-term comatose patients. J Bone Jt Surg Br. 1981;63-B(1):120–5.
62.
63.
64.
65.
Stover SL, Hataway CJ, Zeiger HE. Heterotopic ossification in spinal cord-injured patients. Arch Phys Med Rehabil. 1975;56(5):199–204.PubMed
66.
67.
Tan V, Daluiski A, Capo J, Hotchkiss R. Hinged elbow external fixators: indications and uses. J Am Acad Orthop Surg. 2005;13(8):503–14.PubMed
68.
69.
70.
71.
Uchida Y, Sugioka Y. Ulnar nerve palsy after supracondylar humerus fracture. Acta Orthop Scand. 1990;61(2):118–9.PubMedCrossRef
72.
Vardakas DG, Varitimidis SE, Goebel F, Vogt MT, Sotereanos DG. Evaluating and treating the stiff elbow. Hand Clin. 2002;18(1):77–85, vi.CrossRefPubMed
73.
Viola RW, Hastings H, 2nd. Treatment of ectopic ossification about the elbow. Clin Orthop Relat Res. 2000;(370):65–86.
74.
Wadsworth TG. The external compression syndrome of the ulnar nerve at the cubital tunnel. Clin Orthop Relat Res. 1977;(124):189–204.
75.
76.
Metadata
Title
The Stiff Elbow
Authors
Sumon Nandi
Steven Maschke
Peter J. Evans
Jeffrey N. Lawton
Publication date
01-12-2009
Publisher
Springer-Verlag
Published in
HAND / Issue 4/2009
Print ISSN: 1558-9447
Electronic ISSN: 1558-9455
DOI
https://doi.org/10.1007/s11552-009-9181-z

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