Elbow stiffness
Elbow stiffness is a common yet complex phenotype that often occurs in the post-traumatic setting. The underlying pathologic tissue involved in elbow stiffness may be classified as extrinsic (extra-articular soft tissue structures or heterotopic bone), intrinsic (intra-articular adhesions, loose bodies, or osteophytes), or mixed. Given that the severity of contracture is correlated with the duration of immobilization, the paradigm of management is to regain functional motion progressively while reducing inflammation. Nonoperative management is preferred within 6 months of onset and consists of dynamic serial bracing, static progressive splinting, and examination/manipulation under anesthesia. Operative management should be considered for more chronic stiffness and cases refractory to nonoperative management. The two primary modalities of operative management are arthroscopic and open release. Arthroscopic release is best suited for simple elbow contractures with no prior surgical history. Open release is recommended for more severe extrinsic contractures, heterotopic bone, and nonunion/malunion. Open releases may proceed via an anterior, lateral, medial, or posterior approach. In cases of extreme degradation of the articular surface, interposition, partial, and total elbow arthroplasty may be considered.
