Conditions / Procedures

The Stiff Elbow

Elbow stiffness is common after injury or with arthritis. The propensity of the elbow for stiffness may be due to:

• the high degree of congruency of the elbow joint
• the proximity of muscles such as the brachialis which when traumatised can scar to the capsule and tether normal elbow motion,
• and the high likelihood of intra-articular comminution during fractures.

Elbow stiffness can be classified into extra-articular or extrinsic causes and intra-articular or intrinsic causes. Extrinsic contractures can invole the skin, the muscle and most commonly the joint capsule resulting in a stiff elbow with a normal articular surface. Intrinsic contractures involve intra-articular adhesions or fracture malunions from avascular necrosis, osteochondral fractures or arthritis. With longstanding intrinsic elbow stiffness commonly extrinsic capsular contractures also develop.

Non surgical treatment involves the judicious application of splinting at the end range of motion to develop plastic deformation of the soft tissues through stress relaxation. Gentle active and passive physiotherapy exercises to maintain strength and flexibility are also employed. Non-surgical treatment of elbow stiffness is most successful when done within 3 months after the onset of the stiffness. If this treatment fails, surgery involving capsular release, synovectomy and removal of osteophytes can be done arthroscopically in most cases with a high success rate. You can discuss this procedure at your appointment with the surgeon to find out whether it is suitable for you.