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Painless movement in the elbow joint is critical for normal function, as it allows us to, among other things, pick up food and bring it to the mouth. The loss of this movement due to stiffness after injury can cause significant disability, making it difficult to perform critical activities of daily living.

Post-traumatic elbow stiffness is difficult to treat, and therefore prevention is of utmost importance. Key measures that can be used to prevent post-traumatic elbow stiffness are early surgery for fracture or instability of the joint, as well as active mobilization.

Etiology and symptoms

The tendency of the elbow joint to develop stiffness after trauma is widely recognized among orthopedic surgeons and can occur even after mild injury. In addition to the direct relationship between stiffness and elbow joint trauma, poor rehabilitation, and unnecessary prolonged immobilization, post-traumatic stiffness can be due to various factors that are divided into endogenous and exogenous. Exogenous causes involve the shrinkage of the soft tissues of the joint, while endogenous causes are related to intra-articular fractures, articular cartilage damage, adhesions, and inflammatory diseases, such as osteoarthritis.

The main symptoms of the joint include elbow pain, reduced joint motion, and a feeling of a “locked” elbow.

Treatment

The goal of treatment for post-traumatic stiffness is to restore a functional, if not normal, range of motion of the elbow. Current treatment options range from conservative to surgical, with varying success rates, invasiveness, and complication rates.

The choice of technique to use depends on the etiology of the joint stiffness and the experience of the surgeon.

There are several techniques available if surgical treatment is indicated, such as the following:

• Open surgery to release a stiff elbow
• Arthroscopic repair
• Arthroplasty

Open release

Open surgery to treat post-traumatic elbow stiffness is primarily used in cases where the underlying cause is related to a bone problem. Such problems that affect elbow movement include ectopic ossification, chronic intra-articular fractures, and articular cartilage damage. These conditions are more complex and usually require open surgery.

Arthroscopy

In recent years, arthroscopic surgery has been increasingly used to release a stiff elbow, as it is a minimally invasive technique, and it comes with significant advantages. With arthroscopy, injury to adjacent tissues is minimal, as is postoperative pain, while the recovery time and risk of complications are correspondingly shorter, compared to open procedures. However, arthroscopic rehabilitation is not indicated for all types of stiffness, except in cases of shrinkage of the soft tissues of the joint and for the resolution of adhesions.

Arthroplasty

When conservative treatment and then milder invasive solutions (e.g. arthroscopy) fail, then the ultimate solution to the problem of post-traumatic elbow stiffness is the replacement of the affected joint with a new, artificial one.

Arthroplasty can be total (replacement of the entire joint) or partial (replacement of only one part of the joint, such as the radial head).

However, as an operation it is characterized by significant limitations for the patient, such as the prohibition of lifting weights over 5 kilograms (ideally it is recommended to avoid lifting weights over one kilogram), due to the high risk of wear of the prosthesis and loosening of its materials.

That is why elbow arthroplasty is only indicated in cases of elderly people who have limited requirements.