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Elbow capsulectomy for posttraumatic elbow stiffness.

David Ring1, Lauren Adey, David Zurakowski

  • 1Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, USA. dring@partners.org

The Journal of Hand Surgery
|October 10, 2006
PubMed
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Open elbow capsulectomy improves elbow motion for posttraumatic stiffness. However, patient-reported outcomes are primarily affected by pain and ulnar nerve issues, not just range of motion.

Area of Science:

  • Orthopedic Surgery
  • Reconstructive Surgery
  • Trauma Surgery

Background:

  • Posttraumatic elbow stiffness significantly impairs upper-extremity function and health status.
  • Elbow capsulectomy is a surgical option to address severe posttraumatic elbow stiffness.
  • Factors influencing functional outcomes after this procedure require further investigation.

Purpose of the Study:

  • To identify predictors of diminished elbow function and health status following elbow capsulectomy for posttraumatic stiffness.
  • To analyze the impact of surgical interventions on range of motion and patient-reported outcomes.

Main Methods:

  • Retrospective evaluation of 46 adult patients undergoing open elbow capsular excision for posttraumatic stiffness.
  • Analysis of outcomes an average of 48 months post-surgery, including repeat procedures in 29% of patients.

Related Experiment Videos

  • Stepwise multiple linear regression to determine predictors for American Shoulder and Elbow Surgeons Elbow Score, Mayo Elbow Performance Index, and Disabilities of the Arm, Shoulder, and Hand scores.

    • Main Results:

    • Average improvement in ulnohumeral motion was 53 degrees, with a final average flexion arc of 103 degrees.
    • Repeat capsulectomy yielded limited additional motion (24 degrees).
    • Predictors of poorer outcomes included pain scores, persistent ulnar nerve dysfunction, and duration of follow-up for patient-reported scores (DASH). Flexion arc and pain predicted physician-rated scores (MEPI, ASES).

    Conclusions:

    • Open elbow capsulectomy effectively restores significant elbow flexion arc (average 103 degrees).
    • Repeat surgeries offer marginal gains in motion.
    • Patient-reported health status (DASH) is predominantly influenced by pain and persistent ulnar neuropathy, rather than achieved range of motion.