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. 2020 Jun 25;12(Suppl 1):8661.
doi: 10.4081/or.2020.8661. eCollection 2020 Jun 29.

The stiff elbow: Current concepts

Giulia Masci  1   2 , Gianpiero Cazzato  2   3 , Giuseppe Milano  4   5 , Gianluca Ciolli  1   2 , Giuseppe Malerba  1 , Carlo Perisano  1 , Tommaso Greco  1   2 , Palmacci Osvaldo  1 , Giulio Maccauro  1   2 , Francesco Liuzza  1
Affiliations

The stiff elbow: Current concepts

Giulia Masci et al. Orthop Rev (Pavia). .

Abstract

Elbow stiffness is defined as any loss of movement that is greater than 30° in extension and less than 120° in flexion. Causes of elbow stiffness can be classified as traumatic or atraumatic and as congenital or acquired. Any alteration affecting the stability elements of the elbow can lead to a reduction in the arc of movement. The classification is based on the specific structures involved (Kay's classification), anatomical location (Morrey's classification), or on the degree of severity of rigidity (Vidal's classification). Diagnosis is the result of a combination of medical history, physical examination (evaluating both active and passive movements), and imaging. The loss of soft tissue elasticity could be the result of bleeding, edema, granulation tissue formation, and fibrosis. Preventive measures include immobilization in extension, use of post-surgical drain, elastic compression bandage and continuous passive motion. Conservative treatment is used when elbow stiffness has been present for less than six months and consists of the use of serial casts, static or dynamic splints, CPM, physical therapy, manipulations and functional re-education. If conservative treatment fails or is not indicated, surgery is performed. Extrinsic rigidity cases are usually managed with an open or arthroscopic release, while those that are due to intrinsic causes can be managed with arthroplasties. The elbow is a joint that is particularly prone to developing stiffness due to its anatomical and biomechanical complexity, therefore the treatment of this pathology represents a challenge for the physiotherapist and the surgeon alike.

Keywords: Stiff elbow; elbow; elbow contracture; post-traumatic stiffness.

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Conflict of interest statement

Conflict of interest: The authors declare no potential conflict of interest.

Figures

Figure 1.
Figure 1.
ROM in flexion reduction secondary to right olecranon fracture.
Figure 2.
Figure 2.
X-ray views (AP) showing intraarticular bone fragments.
Figure 3.
Figure 3.
X-ray views (LL) showing intraarticular bone fragments.
Figure 4.
Figure 4.
Functional re-education to pronation-supination.
Figure 5.
Figure 5.
Medial access to isolate ulnar nerve.
See this image and copyright information in PMC

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