Surgical management of elbow flexion contracture in spasticity - A technical guide

Flexion contracture of the elbow is a common and functionally disabling consequence of upper-limb spasticity in children with cerebral palsy and in adults following stroke or traumatic brain injury. Optimal management requires a clear understanding of the underlying neuromuscular imbalance, fixed contracture, and joint stiffness.

This narrative review and monograph is intended to provide clinicians a comprehensive overview of the evaluation and surgical management of elbow flexion spasticity, and to describe a step-by-step technique for multilevel soft-tissue release with or without selective neurotomy.

The article synthesizes current knowledge on pathophysiology, clinical assessment, and indications for surgery, and provides a detailed operative technique based on anatomical principles and the authors' experience. Relevant clinical series from the literature are summarized to illustrate expected outcomes and complications.

Surgical correction combining musculotendinous lengthening, capsular release in selected cases, and selective neurotomy when indicated can restore elbow extension, improve functional reach in selected patients, and facilitate hygiene and care in non-functional limbs. Reported gains in passive extension range from 30 ° to 70 °, with complications being uncommon but including hematoma, sensory irritation, and recurrence.

Multilevel surgical release, when carefully indicated and followed by structured rehabilitation, is an effective option for treating elbow flexion spasticity. A systematic approach to patient selection, surgical planning, and postoperative management is essential to achieve durable results.