Post-traumatic Stiffness (Elbow)

What is Post-traumatic Stiffness? 

Medically, stiffness is difficulty moving a joint due to the loss of the joint’s range of motion caused by an injury (trauma) or a disorder.

Post-traumatic stiffness is a disabling complication caused by trauma resulting in reduced or loss of motion and functional impairment. 

Post-traumatic stiffness in your elbow will make it difficult for you to bend or straighten the elbow and perform daily activities. Post-traumatic stiffness can be extrinsic or intrinsic.

Causes of Post-traumatic Stiffness

The major causes of post-traumatic stiffness in the elbow can be:

• Bone fracture in the elbow
• Previous surgery to the joint
• Loose bodies in the elbow
• Mal-union (improper healing of a fractured bone)
• Bone dislocations in the joint
• Heterotopic ossification (bone growth in non-skeletal tissues)
• Cranial trauma (injury to brain, skull, or scalp)

The cause of post-traumatic elbow stiffness is the basis for its diagnosis and treatment.

Symptoms

Following are the apparent and main symptoms of post-traumatic stiffness in the elbow:

• Pain in the elbow
• A feeling of a locked elbow
• Decreased motion of the joint

Diagnosis

Evaluation of your medical history coupled with a physical examination of the affected elbow is the first step in the diagnosis of post-traumatic stiffness. Subsequently, the doctor will look for the flexion range and inflammation. An X-ray (radiograph), a CT scan or an MRI may also be ordered to confirm the initial diagnosis.

What are the Nonoperative Options?

Splinting (static or dynamic) of the elbow will be the first line of nonoperative treatment. Other options can be:

• Physiotherapy or physical therapy
• Occupational therapy
• Serial casting of the joint
• Movement exercises
• Passive mobilisation
• Joint immobilisation
• Manipulation under anaesthesia
• Administration of NSAID
• Botulinum toxin A injections

What are the Operative Options?

If nonoperative options do not produce results, your doctor may consider surgical procedures such as:

• Open arthrolysis (with external fixation)
• Arthroscopic arthrolysis
• Partial or total elbow arthroplasty
• Interposition arthroplasty
• Corrective osteotomy with arthrolysis
• Capsular release
• Osteophyte excision
• Musculocutaneous neurectomy

These procedures, however, may carry a few post-operative risks like damage to nerves or blood vessels and returning stiffness.

What Happens After Your Surgery?

Soon after the surgery, your elbow will be splinted in extension for 24 hours. The objective is to rest the tissues and minimise bleeding and/or swelling. Once the splint is removed, a compression dressing will be applied. Ice or a compression ice system may be used for 20 minutes every one to two hours during the first 72 hours.

Your Rehabilitation

Postoperative rehabilitation plays an important role in the outcome of your surgery and every patient needs an individualised approach for the best result.

Rehabilitation begins with a continuous passive motion for flexion-extension, 72 hours after the surgery. After six weeks, you may be asked to start static progressive splinting to increase motion. Splinting, therapies and exercises may be required to maintain until a plateau is reached.