Elbow stiffness is common but frequently sub clinical. This is because minor limitations in range are usually well tolerated. Normal range is 0-150 degrees of bend in the elbow with approximately a 140-degree arc of rotation in the forearm. Everyone is different however and a range of 30-130 with 100 degrees of rotation is usually considered “functional”.
The causes of stiffness are usually arthritis and post-traumatic stiffness. In bad trauma, the joint surfaces may be damaged leading to restrictions in range. In addition, scarring from previous surgery or blocks to movement from plates and screws can limit range. Muscle malfunction and guarding can also sometimes cause stiffness. Finally, some people’s elbows develop abnormally in childhood leading to stiffness downstream. An example of this is osteochondritis dissecans where a segment of the joint suffers an interruption in blood supply and may fragment leading to joint irregularity and loose body formation. Imaging is important in interpreting these issues. Plain film and CT scanning are the most useful modalities, but MRI often has a role.
There are limits in what can be achieved safely as rendering the joint unstable by releasing too much can make matters worse. Achieving a functional range rather than a normal range is the goal. Even minor injuries may cause severe thickening in the joint lining (capsule) so releasing the soft tissues may be necessary. Where large gains in range are achieved, releasing nerves around the elbow to allow improved movement without compromising nerve function may be necessary.
If physio and occupational therapy have not managed to achieve a functional range, consideration for surgery is reasonable. In the setting of post traumatic stiffness, it is usually recommended that we wait 9 months or so to allow soft tissue maturity before considering release surgery. This helps avoid rebound stiffness. Depending on whether you have had previous surgery and the amount of deformity involved, open and arthroscopic (keyhole) techniques are available. There are advantages and disadvantages to both.
Consideration to releasing local nerves, typically the ulnar nerve, is often necessary when gains in motion are achieved. This is because the glide of the nerve about the joint during movement becomes constricted by a long period of lack of motion. Adding that motion back can irritate the nerve if it remains immobile.
I will discuss the options depending on the cause for your elbow stiffness with you during your consultation.
The surgery is only the beginning of the journey. A period of splinting is key during the post-operative phase and linking with physio and occupational therapy for rehab and splinting is crucial. This usually means subspecialist therapists and you may require to travel to a specialised unit for this. Sometimes a period as an inpatient with a continuous passive motion machine is required. This is a robot that moves your arm for you to reduce swelling and maximise range in the early stages (typically for 2 days). The rehab after these procedures is long and you need to be patient with it in order to maximise your outcome in terms of range.
Physios: see our therapy guidelines for post-operative care