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I've got a bugger of a bad elbow I need help with. Hurt it in a car accident and can't straighten or bend it all the way. Went to a chiropractor and occupational therapist but still couldn't make any progress. I'm stuck literally and figuratively. Where do I go from here?

Stiffness of the elbow following trauma or injury can be a very difficult problem to solve. Starting with conservative care as you have done is the first step. But, if after three to six months of concentrated, daily work on it, you haven't progressed, then it may be time to check in with a surgeon. Many times, these complex injuries also have nerve damage, muscle tears, and/or ligament ruptures. Sometimes a condition called heterotopic ossification (HO) develops and further complicates matters. HO is the formation of bone in soft tissues where it doesn't belong (e.g., inside the muscle). A surgeon will take a detailed history and evaluate you clinically. Your motion, strength, and condition of the blood and nerve supply will be checked. Imaging studies with X-rays, CT scans, MRIs and sometimes ultrasound help the surgeon identify just what's going on insider there to cause the problem. Arthroscopic exam is the final, most accurate diagnostic test. During the procedure, the surgeon may be able to clean out the joint (remove debris, bone fragments, bone spurs, scar tissue) -- a procedure called debridement. Motion is restored through a process called manipulation as the surgeon gently and carefully moves the joint through its full motion. Surgery isn't the end as you will likely be sent back to the therapist for follow-up treatment. Daily, consistent effort on your part is required to recover motion, strength, and function.

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