Arthroscopic management of the post-traumatic stiff elbow

Abstract

Although there are many causes of elbow stiffness, traumatic injury to the elbow joint is the most common. The true etiology of elbow stiffness can be further categorized as extrinsic (extra-articular) or intrinsic (intra-articular). 4 Bruno R.J. Lee M.L. Strauch R.J. Rosenwasser M.P. Posttraumatic elbow stiffness: evaluation and management. J Am Acad Orthop Surg. 2002; 10: 106-116 PubMed Google Scholar Traumatic injury to the elbow often involves a combination of fracture (intra-articular and/or extra-articular) and partial or complete dislocation with concordant ligamentous, neurologic, and muscular injury. 21 Protzman R.R. Dislocation of the elbow joint. J Bone Joint Surg Am. 1978; 60: 539-541 PubMed Google Scholar These injuries commonly result in hemarthrosis and subsequent scarring and contracture, along with the anatomic disruption caused by the initial trauma. Initial surgical intervention, postoperative immobilization, and postoperative rehabilitation, though necessary, may worsen the initial soft-tissue injuries. 24 Tucker K. Some aspects of post-traumatic elbow stiffness. Injury. 1977; 9: 216-221 Abstract Full Text PDF Scopus (24) Google Scholar These associated problems can produce debilitating long-term sequelae, including postoperative incisional scarring, bony malunions and nonunions, osteochondral defects or hypertrophic fracture callus, heterotopic ossification, ligamentous imbalances, compressive or scarring neuropathies, and muscular damage with associated scarring and loss of normal motion. 24 Tucker K. Some aspects of post-traumatic elbow stiffness. Injury. 1977; 9: 216-221 Abstract Full Text PDF Scopus (24) Google Scholar Any of these long-term complications may result in altered elbow mechanics, functional impairment, and prolonged pain. Pain then gives way to voluntary and involuntary guarding of the elbow, thereby exacerbating the already present capsular and muscular contracture. This mechanism of pain generation is often the culprit leading to post-traumatic elbow stiffness, in some cases from relatively minor elbow trauma. Therefore, elbow stiffness must be assessed from an arthrofibrotic and/or arthritic standpoint and appropriate treatment modalities applied. 4 Bruno R.J. Lee M.L. Strauch R.J. Rosenwasser M.P. Posttraumatic elbow stiffness: evaluation and management. J Am Acad Orthop Surg. 2002; 10: 106-116 PubMed Google Scholar