DESCRIPTION AND SYMPTOMS
What is elbow stiffness?
Elbow stiffness is the loss of elbow joint mobility. There are a number of reasons why it can occur, as any of the described joints in it is liable to cause it, but the result of any of them is the loss of flexing, extending, and twisting movements of the elbow. This loss of elbow flexion often leads to a decrease in the individual’s ability to perform everyday activities such as driving or washing.
When assessing elbow stiffness, it is necessary to determine the patient’s medical history, such as if they have had previous trauma to the area or any related surgeries. This is because when diagnosing elbow stiffness, the injury is classified according to the state of the joint: we speak of an intrinsic cause (when there are degenerative changes in the joint) or extrinsic (where the joint is in good condition but the tissues that surround it are not).
Other similar injuries to the elbow, and in which the arthroscopic surgical technique can be used, are golfer’s elbow and el tennis elbow.
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What are the symptoms of frozen elbow?
Pain and loss of mobility of the elbow, which can appear suddenly, or gradually establish itself over time.- Inflammation in the elbow area.
- Decreased quality of life, as frozen elbow can be very disabling for the patient, preventing them from doing simple, day-to-day such as personal hygiene.
Pain and loss of mobility of the elbow, which can appear suddenly, or gradually establish itself over time.A high percentage of the problems associated with stiff elbow follow after surgery or an immobilization period. It’s therefore important that, when evaluating a patient for frozen elbow, an exhaustive study is carried out, especially to rule out infections in patients who have undergone surgery.
If the injury is not treated in time
Among the main problems related to not treating this injury in time are:
Work
Decreased mobility limits daily work activities and may even limit your ability to drive.
Sport
Most of the people who continue a sporting activity with frozen elbow will suffer limitations as the elbow influences many movements required across a range of sports.
Stiffness
Applying the wrong treatment and not catching the injury in time can cause pain and chronic stiffness in the elbow.
TREATMENT
What is the treatment for stiff elbow?
Treatment for elbow stiffness is complex, so prevention is paramount. Avoiding prolonged immobilization of the elbow and initiating early rehabilitation treatments is vital to avoid frozen elbow.
When treatment becomes necessary, it is based on a combination of physical therapy and the use of dynamic and static orthoses (supports) to help the joint to move and to heal. This programme of joint exercises and manipulation techniques should be followed for at least 3-6 months.
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Surgical treatment is recommended for those patients with persistent mobility limitation despite physiotherapy treatment. If joint flexing mobility does not exceed 100º and extension mobility is below 30º, surgical treatment is recommended. In surgery:
- If the joint is in good condition, an arthrolysis or release of the contracture is performed. There are two ways to perform the release: by open surgery or by arthroscopic surgery.
- If the joint is affected, the patient should undergo joint replacement procedure. That is, implantation of a prosthesis.
How is arthroscopic surgery to improve elbow mobility performed?
Arthroscopic surgical treatment to improve elbow mobility is called arthrolysis. It is performed using an arthroscopy, or a small camera, that allows the surgeon the joint and remove any loose bodies, and/or osteophytes (extra bone that “grows” into the joint) that impede mobility.
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Among the advantages of the arthroscopic surgical technique versus open surgery is a shorter recovery time, allowing the patient to return to more quickly return to a higher quality of life.
FREQUENTLY ASKED QUESTIONS
How long does arthroscopic surgery for stiff/frozen elbow take?
Duration time varies depending on factors such as the surgeon’s experience, the type of injury being treated, and the characteristics of the patient. In the case of an elbow arthroscopy, the duration is around an hour and a half or two hours: enough time for the surgeon to penetrate the elbow joint and remove all adhesions, loose bodies or synovial tissue that prevents mobility.
How is an open arthrolysis surgery performed?
Open arthrolysis is the classic technique for treating elbow stiffness. Sometimes in patients whose stiffness is of mixed cause, this open surgery is necessary to regain full mobility of the elbow, by allowing the surgical team to remove the part of the bone or ligaments that are blocking movement.
What is recovery like after an arthroscopic arthrolysis surgery?
- Recovery after an elbow arthrolysis requires close collaboration between the patient, the surgeon, and the physical therapist throughout the rehabilitation period. Direct communication and multidisciplinary work are key to an effective and complete recovery of joint mobility in the shortest possible time.After surgery, about 10-15% of patients will develop tingling or other unexplained sensations (“paresthesias”) in the ulnar nerve.
What are possible complications from an arthroscopic surgery for stiff/frozen elbow?
- It is important when considering this surgery to clearly establish with the patient the expectations of it, since in most cases full mobility will not be restored. In more than 50% of the cases, patients recover mobility in the functional range, that is, 30º to 130º of flexion.
- After surgery, patients may present paresthesias in the ulnar nerve. About 10% of patients have non-permanent tingling in the 4th-5th fingers of the hand.
REFERENCES
Attum B, Obremskey W. Posttraumatic Elbow Stiffness: A Critical Analysis Review. JBJS Rev. 2016 Sep 6;4(9):01874474-201609000-00002. doi: 10.2106/JBJS.RVW.15.00084.PMID: 27760073
Zheng W, Liu J, Song J, Fan C Risk factors for development of severe post traumatic elbow stiffness. Int Orthop. 2018 Mar;42(3):595-600. doi: 10.1007/s00264-017-3657-1. Epub 2017 Oct 7.PMID: 28988397
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