Elbow Contracture 718.42

synonyms: elbow stiffness, elbow contracture, frozen elbow

• <1 yrs duration = stretching exercises, dynamic splinting, and adjustable static night splints
• surgical release for contracture >30 degrees that has failed non-op management.  Results of surgical relase for contracture <30 degrees is unpredictable
• Anterior capsulectomy and CPM (Gates HS III, JBJS 74A;1229;1992)

Elbow Contracture ICD-9

• 718.42 (elbow contracture)

Elbow Contracture Etiology / Epidemiology / Natural History

• Loss of terminal extension is typically well tolerated, except in gymnasts and basketball players. Loss of flexion affects Activities of Daily Living and is not well tolerated.

Elbow Contracture Anatomy

• Functional elbow ROM: Flex/extend 30° -130° , pronatation = 50° , supination = 50° (Morrey BF, JBJS 63A;872:1981).

Elbow Contracture Clinical Evaluation

• Complain of pain and limited ROM
• Document ulnar nerve function.
• Note any prior incisions or skin grafts(burns)

Elbow Contracture Xray / Diagnositc Tests

• A/P, lateral and oblique elbow films indicated.

Elbow Contracture Classification / Treatment

• Initial Treatment: physical therapy with static progressive splinting. (Doornberg JN, JOT 2006;20:400).
• Arthroscopic release (Nguyen D, Arthroscopy 2006;22:842) (Ball CM, JSES 2002;11:624),
  -See Elbow Arthroscopy
  -Anterior capsule is release with a blunt-tipped obturator using a sweeping motion from distal to proximal to increase the joint space.
  -Synovial is debrided with shaver, always keep shaver directed toward bone, minimize use of suction.
  -Sharp capsular release is then perform using an arthroscopic bitter from lateral to medial.
  -Capsule debrided with shaver.
  -Gentle manipulation should then allow full extension. Consider viewing form lateral portal to ensure anteromeidal capsule was released. Record post-operative motion.
• Open release (Marti RK, Acta Orthop Scand 2002;73:144). (Tan V, J Trauma 2006;61:673).
• Consider prophylactic ulnar nerve decompression or transposition in patients with 90°-100° flexion deficits, to decrease risks of post-operative ulnar neuropathy.

Elbow Contracture Associated Injuries / Differential Diagnosis

• Elbow Arthritis

Elbow Contracture Complications

• Continued stiffness
• Ulnar nerve palsy

Elbow Contracture Follow-up Care

• Post-op: place in extension with an anterior splint to maintain maximum extension for 24-48 hours.
• 2 Days: Splint removed. Evaluate ROM. Start active and active assisted ROM with goals of full flexion/extension, supination/pronation.
• 2 Weeks: Evaluate ROM/Progress.
• 3Weeks: Evaluate ROM. Consider manipulation under anesthesia if motion is not continueing to improve significantly. Consider static progressive splinting.

Elbow Contracture Review References

• OKU - Shoulder and Elbow 2nd ed, 2002
• Jupiter JB, ICL 2003;52:93
• Operative Elbow Surgery: Expert Consult: 2012
• AAOS/ASES Advanced Reconstruction Elbow, 2007
• Orthopaedic Knowledge Update: Shoulder and Elbow, No. 3