Elbow Trauma and Treatment for Stiff Elbows
A large majority of my fellowship training in hand and upper extremity surgery was spent studying and learning about elbow trauma. Typically, I’ll see elbow traumas that involve elbow dislocations, elbow dislocations with associated fractures, distal humerus fractures, olecranon fractures and radial head fractures.
Treatment options for the elbow conditions I’ve listed vary on an individual basis, but there is one underlying theme. Regardless of whether surgery is needed or not, we want to obtain a stable elbow. If the elbow is stable without orthopedic surgery, then we will feel comfortable going ahead and working closely with our therapists to begin a rehabilitation program (aka physical or occupational therapy). If we see any sign of instability or there is a fracture involving the joint surface, then often times we will need to go in with orthopedic surgery to repair the ligaments or restore the articular surface.
Once we have decided that the elbow is stable, whether that was initially or after surgery, patients will typically stay in a splint, but then they will meet with our occupational therapists, typically two to three times a week, to come out of the splint and work on specific elbow range of motion exercises. These exercises are then performed at home. We really want to encourage elbow range of motion to prevent elbow stiffness.
In some circumstances, despite our best efforts, patients can sometimes still develop a stiff elbow. That can be very frustrating for the patient, the therapists and the treating physician(s), but it is often not the fault of any of the above. Sometimes the body forms excess scar tissue or excess bone, or there may be inflammation around one of the nerves that prevents movement of the elbow.
Patients will typically come see me for a stiff elbow when they have trouble performing their activities of daily living. The literature will suggest that an individual needs approximately 100 degrees of elbow range of motion—from 30 degrees to 130 degrees—but what we’ve found is that with our lives and talking on the phone or buttoning our collars, even that much range of motion can be difficult for some patients.
A patient may be working with a physical therapist and—despite going two to three times per week—they may not see any improvement in their elbow range of motion. If the patient is four or five months out from orthopedic surgery and they have built up scar tissue, at that point it is unlikely the patient’s range of motion is going to improve with therapy alone. It is at that point that I will have a discussion about operating on the patient’s elbow to release any excess bone formation or any excess scar tissue formation to help improve the patient’s range of motion.