Managing the stiff elbow: operative, nonoperative, and postoperative techniques

Area of Science:

• Orthopedics
• Physical Therapy
• Rehabilitation Medicine

Background:

• Elbow contracture results from intrinsic (intra-articular) or extrinsic limitations.
• Accurate evaluation of affected structures is crucial for effective treatment planning.
• Intrinsic contractures, caused by joint incongruency, are less responsive to non-operative interventions.

Purpose of the Study:

• To outline effective non-operative and operative treatment strategies for elbow contracture.
• To detail the components of preoperative and postoperative therapy programs.
• To highlight the importance of patient compliance and potential complications.

Main Methods:

• Non-operative treatments include modalities, soft tissue mobilization, joint mobilization, muscle energy techniques, range of motion exercises, and corrective splinting.
• Preoperative therapy (6-8 weeks) aims to reduce extrinsic contractures and assess patient compliance.
• Operative treatment involves sequential release of limiting structures and potential reconstruction for stability.

Main Results:

• Non-operative therapy can address extrinsic limitations, while intrinsic contractures require surgical intervention.
• Postoperative therapy, including continuous passive motion and corrective splinting, is essential for maintaining surgical gains.
• Extensive patient participation is vital for maximizing functional outcomes.

Conclusions:

• A comprehensive approach combining non-operative and operative strategies, tailored to the specific limitations, is necessary for managing elbow contracture.
• Postoperative rehabilitation is critical for long-term success and requires significant patient commitment.
• Potential complications include nerve injury, instability, heterotopic ossification, and recurrence.