Abstract
Loss of elbow motion can lead to disability in everyday gestures, recreational activities, and work. Unfortunately, the elbow joint is particularly prone to stiffness because of its complex anatomy and biomechanics. The etiology of elbow stiffness is varied and must be diagnosed accurately in order to allow optimal treatment, which may be challenging for surgeons and physiotherapists. Its treatment can be either conservative, arthroscopic or surgical, with a trend for arthroscopic procedures when conservative treatment fails. There is no consensus on the optimal imaging workup for elbow joint stiffness, which may have an impact on patient management. This article reviews the current classification systems of elbow stiffness and the various imaging techniques used for diagnosis. Report checklists and clarifications on the role of each imaging method, as well as the imaging findings of normal and stiff elbows, are presented, leading to a proposed diagnostic algorithm. The main concern in imaging is to determine the cause of elbow stiffness, as many concomitant abnormalities might be present depending on the clinical scenario.
Highlights
There is no consensus on the optimal imaging workup for elbow joint stiffness, which may have an impact on patient management
The etiology of elbow stiffness is multifactorial, it is most frequently caused by an association of tethers and/or blocks, essentially secondary to trauma and OA
Elbow stiffness can involve multiple intra-articular or extra-articular structures, such as capsular, and periarticular soft tissues and the imaging workup is paramount for optimal patient management
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Elbow joint stiffness is thought to result from post-traumatic capsular thickening with disorganized collagen fibers, altered cytokine levels, and elevated myofibroblasts [7]. The etiology of elbow stiffness is varied and must be diagnosed accurately in order to allow the best therapeutic management, which may represent a challenge for surgeons and physiotherapists. Its treatment can be either conservative (e.g., physiotherapy and splinting), arthroscopic (e.g., most frequently: anterior capsular resection, cleansing the humeral fossae, osteophyte and loose bodies ablation) or surgical (e.g., open elbow arthrolysis and prosthetic joint replacement) [8,9]. There is no consensus on the optimal imaging workup for elbow joint stiffness, which may have an impact on patient management. MRI excels in demonstrating capsular and periarticular soft tissue anomalies, its role in elbow stiffness workup is not well defined. After a key anatomical and biomechanical review, the different etiologies of elbow stiffness are reviewed, and a practical diagnostic and pretherapeutic imaging approach is proposed
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