The elbow joint is a type of hinge
joint. It bends (flexion) and straightens (extension), as well as rotating to
position your palm up or down. The normal range of flexion and extension is
from 0 to 145 degrees, although the range of motion that we work within for
daily activities is only from 30 to 130 degrees. This means that for most
people a bit of loss of motion does not cause problems with function. However,
with a reduction of extension greater than 30 degrees and or a flexion less
than 130 degrees most people will complain of loss of function. Loss of
extension is usually less disabling than loss of same degree of flexion.
Factors that cause stiffness are
divided into those that are within the elbow joint itself (intrinsic) and those
in the tissues around the joint, such as the muscles andtendons (extrinsic).
Intrinsic / Intra-articular Causes
Extrinsic / Extra-articular Causes
congenital – arthrogryposis, congenital disloc radial
The commonest cause of stiffness is
after trauma and injury. In fact, some stiffness after an elbow injury is very
common. Usually this improves, but sometimes it may not. The amount of
stiffness isdirectly related to the degree of initial trauma and the degree of
involvement of the joint surfaces is most important. The length of
immobilisation after injury also leads to more long-term stiffness.
The ‘Simple’ Stiff Elbow is one that recovers well. The criteria are:
Mild to moderate contracture
No or minimal prior surgery
No prior ulnar nerve transposition
No or minimal internal fixation in
No or minimal heterotopic
ossification (bone in the muscles)
Normal bony anatomy has been
The aim is to give the patient
pain-free, functional and stable elbow. This means 30-130 degrees flexion and
100 degrees of rotation.
Physiotherapy involves passive motion exercises and stretching (not too
aggressive) and active exercises. Ideally this should be with a physiotherapist
who has an interest in upper limb rehabilitation.
Splinting may be used and is well tolerated and is effective when
performed in a static progressive fashion.
Surgery is indicated when patients are no longer improving in their
original post traumatic rehabilitation program. At least 3 to 6 months should
be allowed for the inflammatory phase of soft tissue healing to resolve.
This may be performed via keyhole (arthroscopy) or open surgery. The decision depends on the surgeon’s
experience and the type of stiffness.
release is ideal for stiffness due to arthritis and when there has been no
previous surgery. However, if there has been a previous internal fixation and
there are extrinsic causes for the stiffness open surgery is required.