Stiffness

What is it?

The elbow is made up of three joints which may succumb to stiffness through trauma, surgery or degenerative change. This can be due to a change in any of the surrounding structures that affects elbow flexion, extension, pronation and/or supination of the forearm. Any restriction in movement can result in pronounced difficulty conducting day to day activities such as washing, dressing and cooking.

 

Why does it occur?

Elbow stiffness can be caused by changes to the bone, such as arthritis and osteophyte formation, or damage to any of the soft tissue structures such as the joint capsule. Tears or injury to the capsule leads to scarring and tightening of the joint. 


What are the symptoms?

Typical symptoms include pain and reduced range of motion in the forearm. You may find simple tasks increasingly difficult or require more assistance.

 

How is it diagnosed?

This will be based on a thorough history, clinical examination and further imaging such as X ray or ultrasound.

 

How is it treated?

Non operative 

Aims of treatment are to increase range of movement in the elbow without pain. Physiotherapy with targeted regular exercise is crucial in achieving this, occasionally splinting is recommended which acts to bend the elbow over time.

 

Operative

Surgery may be considered in those where conservative management has failed. Often conducted via a minimally invasive or arthroscopic approach, the plan is dependent on what is specifically impairing elbow movement. Debridement of scar tissue or bony involvement may be warranted, alternatively a scarred, constricted joint capsule will require release. In some circumstances scar tissue can constrict the nearby ulna nerve causing pain. Ulna nerve decompression may be done at the time to remove this fibrous tissue and improve symptoms.

 

Recovery is quicker in those deemed suitable for arthroscopic or minimally invasive surgery. Post-operative physiotherapy is crucial in maintaining the improved range of movement as scar tissue can form leading to symptom recurrence.