Operative Treatment of Elbow Stiffness.

INTRODUCTION

Open elbow contracture release is the mainstay for the operative treatment of posttraumatic elbow stiffness.

STEP 1 SKIN INCISION: Use either a posterior skin incision and raise medial and lateral skin flaps or use more direct individual medial and lateral skin incisions.

STEP 2 PROTECT OR RELEASE PERIPHERAL NERVES: Release the ulnar nerve using a small incision and in situ release when a lateral muscle interval (between the extensor carpi radialis brevis and extensor digitorum communis muscles) is preferred for the contracture release; use a larger incision with subcutaneous anterior transposition when a medial muscle interval (50:50 split of the flexor pronator mass) is used.

STEP 3 DEVELOP MUSCLE INTERVALS FOR EXPOSURE OF THE JOINT: Choose a lateral (extensor carpi radialis brevis/extensor digitorum communis) or medial (50:50 split of the flexor pronator mass) muscle interval to expose the elbow capsule.

STEP 4 RESECT BONE CONTRACTED CAPSULE AND IMPLANTS RESTRICTING MOTION: Remove the structures that hinder motion: implants, heterotopic bone, and contracted capsule.

STEP 5 TENOLYSIS/MUSCLE ELEVATION: When the triceps and the brachialis muscles are adherent to the distal third of the humerus, release them using an elevator.

STEP 6 MANIPULATE ELBOW CONSIDER IMPLANT REMOVAL: Take care not to push so hard that you fracture the bone at a stress riser created by removal of bone or implants.

STEP 7 WOUND CLOSURE: Close the muscle intervals and skin.

STEP 8 POSTOPERATIVE MANAGEMENT: The key after surgery is frequent, active, patient-assisted elbow flexion, extension, and forearm rotation stretches.

RESULTS

A case series of patients with elbow contracture release documented an average improvement in the arc of elbow flexion of between 21° and 66°.

WHAT TO WATCH FOR

IndicationsContraindicationsPitfalls & Challenges.