ELBOW

ELBOW STIFFNESS

The most common complication following any elbow surgery or injury is stiffness. It is also possible for excess bone to form in the soft tissues around the elbow, called heterotopic ossification. It is best to prevent a stiff elbow by movement of the elbow as soon as practical. The surgeon will balance soft tissue considerations, fracture stability and other patient factors when deciding whether to move the elbow early or not. If the elbow becomes stiff it can sometimes be splinted back to a functional range of motion. This is most effective in the first six months following injury or surgery. Typically this involves soft tissue stiffness only and will not overcome joint deformity.

If all non operative measures have failed, a surgical stiff elbow release can be performed. This is typically performed when patients are no longer able to put their hand to their mouth, or lose more than half of their straightening ability.

Stiffness can be...

1. Within the joint,
2. Because of the joint, or,
3. Outside the joint.

Your surgeon will discuss your particular problem and its treatment with you.

There are many different methods of performing a stiff elbow release. Nowadays, a significant portion of the surgery is usually done arthroscopically (with keyhole surgery) but often an open incision is required. If the elbow does not bend beyond a right angle you will almost certainly require release of the nerve at the inside of the elbow (the ulnar nerve) to prevent problems with the nerve following the surgery. While the risk of complication is quite low with this type of surgery, the consequences of a complication can be significant. This is particularly true with regard to hand function if one of the nerves which supplies the muscles in the hand and/or skin sensation is damaged.

There is a significant post operative rehabilitation period required following the surgery. This may involve up to 5 days in hospital on a machine which moves the elbow for you and, depending on the type of operation, either a splint or movement machine at home for a period of weeks as well.

While there are risks involved with this type of surgery, the results are quite gratifying. At least 80 percent of patients achieve a fully functional elbow and 90 percent of patients are within 10 degrees of this.

The pre-operative range of movement does not necessarily dictate the final motion gained, although it does determine the complexity of the operation which is required.