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Manipulation under anesthesia for posttraumatic elbow stiffness: a propensity score matched retrospective cohort
Lihua Huang1, Yanmao Wang2, Shiyang Yu2
1Department of Rehabilitation, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Scientific Reports
|April 20, 2026
Summary
Early manipulation under anesthesia (MUA) combined with rehabilitation offers modest improvements in elbow range of motion and function for post-operative stiffness. While statistically significant, the gains were small and may not be clinically meaningful, with minimal cost increase.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Health Economics
Background:
- Post-traumatic elbow stiffness frequently limits patient mobility and function following surgery.
- Current treatments like open surgical release are invasive, while manipulation under anesthesia (MUA) lacks robust comparative evidence.
- Early intervention is crucial for managing elbow stiffness post-orthopedic surgery.
Purpose of the Study:
- To evaluate the efficacy of early manipulation under anesthesia (MUA) plus rehabilitation versus rehabilitation alone for post-operative elbow stiffness.
- To compare improvements in elbow range of motion, pain, and functional outcomes between the two treatment groups.
- To assess the cost-effectiveness of early MUA in managing elbow stiffness.
Main Methods:
- A retrospective propensity score-matched cohort study involving 240 patients with post-operative elbow stiffness.
- Two groups were compared: 120 patients receiving MUA (6-12 weeks post-surgery) followed by rehabilitation, and 120 matched controls receiving rehabilitation only.
- Standardized physiotherapy was administered for 3 months; outcomes were assessed over 12 months using ROM, ASES, DASH, and EQ-5D-5L scores, with cost analysis performed.
Main Results:
- The MUA group recovered 5.9% more lost elbow motion by 6 months and 6.4% by 12 months compared to controls.
- A greater elbow flexion-extension arc (6.1° at 1 year) was observed in the MUA group, though below the minimal clinically important difference (MCID).
- Functional scores (ASES pain and function) improved more in the MUA group, but upper-extremity disability and health utility were similar; costs were nearly identical.
Conclusions:
- Early MUA combined with rehabilitation demonstrated statistically significant but modest improvements in elbow range of motion and functional scores compared to rehabilitation alone.
- The observed gains in motion did not reach the MCID, raising questions about clinical relevance despite minimal additional cost.
- Further high-quality randomized controlled trials are necessary to confirm the clinical benefit of early MUA for post-traumatic elbow stiffness.
