Options for Splinting as Treatment for Post-traumatic Elbow Contracture

Loss of range of motion due to capsular contracture of the elbow is not uncommon following traumatic injury to the joint. Nonsurgical options for treatment of the contracture include splinting and stretching exercises supervised by an occupational or physical therapist. Splinting can either be done statically or dynamically and may or may not include a turnbuckle feature.

Static progressive splinting does not allow the elbow to move and is typically used for short periods of time in a position that forces the elbow in one direction. The patient can control the force with guidance from their doctor and physiotherapist. Dynamic splints have a hinge at the elbow and a mechanism that allows some movement of the elbow while being stretched the rest of the time. These splints are worn for longer periods of time as they work by applying a low load prolonged stretch that typically causes little discomfort to the patient. The turnbuckle splint can be static or dynamic and allows the hand to pronate and supinate, or twist up and down.

The protocols for splinting vary greatly, but result in similar outcomes. Though static splints are typically worn for shorter periods of time, often in 30 minute increments several times a day, some protocols have the patient wearing the splint all day in varying positions. The range of motion gained with static splinting can vary, with reported results ranging from 26 degrees to 50 degrees. There is less research reporting protocols and results with dynamic splinting, but typically these splints are worn for at least six hours/day and often 24 hours a day. Range of motion gains vary from 20 to 47 degrees as reported in the literature.

Range of motion can continue to improve for up to a year after injury, with the greatest gains being made in the first three months. It is important that the patient understands this and prepares mentally to allow the stretching to take place in the early months. There is evidence that patients who have a protective attitude toward stretching in the first month of recovery gain less range of motion.