Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Examination Under Anesthesia
Introduction
Since motion loss is such a major problem at the elbow, the question of manipulation is a common one. I do stretch the elbow under anesthesia, but I avoid and object to the term manipulation because I truly perform an examination of the elbow with a component that gently stretches the arc and disrupts scar and adhesions. The components of the examination are (1) to assess the firmness of the motion restriction and then to stretch the end points of the arc of motion; (2) to determine the degree of crepitus or the smoothness of the articulation; and (3) to assess the joint for stability.
Indications
There are no absolute indications for this procedure. It is very much a matter of judgment that is predicated on the course of the patient's recovery. In my practice, an examination under anesthesia of the stiff elbow is performed in two settings. The first is at the time of removal of an external fixator. Because one indication for the use of the external fixator is to manage the stiff elbow, it is logical to perform an examination at the time of removal. The second circumstance is when the patient exhibits failure to gain or to be making progress toward gaining a functional arc motion after trauma or surgery. More specifically, if after 2 or 3 months the patient has demonstrated significant loss of motion compared to what was obtained at the time of surgery and is no longer improving after fracture fixation, or is getting worse, then we would examine that elbow under anesthesia.
Contraindications
The contraindications to examination under anesthesia are relative and include concern about wound healing, tenuous fracture healing, a time from surgery that is too early to determine its necessity—that is, less than 1 month—and a duration of the ankyloses of more than 6 to 9 months.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here