Treatment Options for Stiff Elbow

When someone develops a stiff elbow that's stiff enough to interfere with range-of-motion and functioning, treatment is usually needed. Some people may not bother seeing a doctor because elbows often don't have to have full range of motion to be used effectively. Most activities require the elbow to bend between 30 degrees and 130 degrees - neither full bend or full extension usually. However, depending on the activities you do, you may need the full extension or flexion (bending).

The elbow has three distinct sections called the single synovial capsule, the ulnotrochlear joint, and the proximal radioulnar joint. These are what allow the elbow to make the movements it can.

When an elbow is stiff, it could be caused by any one of a number of reasons that are intrinsic or extrinsic (from inside or outside forces). Extrinsic factors can include contractures (tightening of the tissues that normally allow your to open and close your elbow angle, by issues with the bones, such as bones not healing after a fracture, (nonunion), or even the skin that can scar badly after a burn, for example, causing the elbow to contract. Intrinsic causes include illnesses like arthritis or something internal that changes the structure of the joint.

A stiff elbow isn't necessarily painful, but if there is pain, when it occurs is an important clue to determining why it's stiff. For example, if the pain is only present when the elbow is actually bending, this may tell the doctor that the problem is an intrinsic one. The doctor will need to know information such as the patient's general health, if there was any trauma at all, even the slightest one can be significant if the patient has an illness such as diabetes.

X-rays will help see if there is any damage to the joint and stress x-rays may help the doctor see if the elbow is stable and a CT scan (computed tomography imaging) may also be helpful. Occasionally, an MRI (magnetic resonance imaging scan) will be done to check for soft tissue damage that can't be seen on an x-ray. Another issue doctors must check in to is infection. This is a possibility of the elbow is quite painful, even at rest.

Treatment of a stiff elbow depends on what the cause is. If a patient has osteoarthritis of the elbow, the so-called wear-and-tear arthritis, the doctor knows that the joint is still intact and can work with that. On the other hand, if the cause is due to pieces of bone breaking off and lodging in the joint, surgery will be needed to remove those pieces. Surgery may also be needed to release contractures or to remove tissue that may be pressing on the ulnar nerve, the nerve that passes down through the elbow.

If it's decided that a nonsurgical approach will be taken, one study, done by Doornberg and colleagues, found that progressive splinting of the elbow helped increase the elbow's ability to bend, but the trick seemed to be that the splinting had to be done as soon as possible after the splinting rather than after an old injury.

When treating children, doctors are concerned about poor and unpredictable results. Researchers Madel and colleagues did perform surgery on the elbow in teens and, although the surgery itself was complicated, the results seemed to be promising.

The advent of arthroscopic surgery, where tiny incisions are made and surgery is done with long instruments that reach inside the incisions, has been good for elbow surgery. This allows surgeons to remove tissue from the elbow without making large incisions. If the elbow is stiff because of a trauma or injury, the results were best if the surgery was done within one year of the injury.

Finally, Botox may also be a form of treatment for stiff elbow. By injecting Botox into a severely contracted elbow, the elbow may relax.

This article's author suggests that the focus needs to be on preventing stiff elbow to begin with. If a patient presents with an elbow injury, there is an increased risk of developing a stiff elbow if the problem was caused by major elbow trauma or burns, for example.

Reference: 

Christopher Chuinard. The stiff elbow. In Current Orthopaedic Practice. November 2008. Vol.19. No. 6. Pp. 602-607.

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