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Elbow Stiffness: Arthroscopic Contracture Release


Introduction

Restoration of elbow motion in patients with stiffness is commonly attempted arthroscopically. The reader should refer to Part 2 for an in-depth review of arthroscopic elbow surgery. Chapter 21 reviews the arthroscopic management of the arthritic elbow, and many of the concepts summarized here overlap with that particular chapter. In this chapter, we will provide a more concise review of contracture release when performed arthroscopically.

General Principles

Careful evaluation of the elbow is paramount to the success of arthroscopic contracture release. Contemporary arthroscopic procedures allow accurate and complete removal of sources of mechanical impingement that limit motion. Likewise, adequate removal of the contracted capsule can also be performed arthroscopically. However, arthroscopically assisted interposition procedures are still in their infancy; when restoration of motion requires addressing the joint surface, either to smooth an arthritic joint or to correct incongruity or malunion, open surgery is often required. In simple terms, arthroscopy is great for extrinsic stiffness but not so much for intrinsic stiffness. For these reasons, one of the main goals of the evaluation is to determine if the patient has intrinsic or extrinsic stiffness. The key pieces of information that need to be collected when assessing a patient considered for arthroscopic contracture release are summarized in Box 55.1 .

Box 55.1
Patient Evaluation

Range of Motion

  • Accurate measurement and record of flexion, extension, pronation, and supination

  • Understand individual needs and expectations in terms of motion

Etiology

  • Posttraumatic stiffness

  • Primary elbow osteoarthritis

  • Inflammatory arthritis

  • Developmental

  • Other

Condition of the Joint Surface

  • Articular shear test

  • Imaging studies

Condition of the Ulnar Nerve

  • Normal, subclinical neuropathy, or established neuropathy

  • Has it been surgically decompressed or transposed?

Condition of the Skin

  • Previous skin incision(s)

  • Burns, flaps or other areas of extensive skin scarring

Imaging Studies

  • Plain radiographs

  • Computed tomography with three-dimensional reconstruction

  • Nerve trajectory using ultrasound or computed tomography

  • Magnetic resonance (rare, detailed cartilage evaluation)

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