Elbow Contracture Release
After an injury, even sometimes a simple fall, the elbow can develop significant stiffness. This is usually seen after a dislocation or fracture but can also be seen secondary to arthritis. The loss of motion can be secondary to either soft tissue scarring with significant thickening of the elbow capsule (the "balloon" around the joint that contains the joint fluid) or there can also extra bone (heterotopic ossification) formed in soft tissues which normally do not have bone. Loss of motion of the elbow can be quite disabling to an individual making even normal daily activities difficult. Full range of motion is from 145 degrees of flexion to 0 degrees of extension.
Loss of elbow motion can significantly affect an individual's day-to-day life, making even simple activities such as getting dressed, feeding oneself and using a keyboard difficult. There can also be associated pain. Prior to considering surgery the physician should exhaust all reasonable non-surgical alternatives of management. Trials of activity modification, gentle physical therapy and elbow splinting may be sufficient to restore enough motion that the patient can function well.
Typical motion loss in an individual requiring contracture release is seen in this patient.
This individual had only 105 degrees of elbow flexion and lacked 50 degrees of elbow extension.
Elbow contracture release surgery can be done either arthroscopically or through a small open incision on the elbow. The type of anesthesia is typically a regional block where the nerves to the arm and hand are numbed and the patient is then sedated. At times a general anesthesia is necessary. All thickened and abnormal scar tissue, as well any heterotopic bone, is removed. Removal of thickened capsule allows for restoration of range of motion. Care is taken to preserve the normal elbow ligaments. Nerves are decompressed and freed up from surrounding scar tissue as necessary.
Physical therapy is started within 24 hours of surgery. A continuous passive motion (CPM) machine is often utilized for the first several weeks after surgery to aid in the rehabilitation. This is used in the patient's home. The patient is also taught other simple exercises which they do on their own at home two to three times a day. It is usually not necessary for the patient to attend outpatient physical therapy. Activities such as golf and swimming are allowed after six weeks.
Post-operative range of motion in same patient:
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