Review of Treatment for Elbow Contractures

Contracture of the elbow can be described as a stiff elbow joint. It won't move all the way into flexion, extension, or both. Sometimes the person has trouble turning the hand palm up or palm down. The cause can be from something intra-articular (inside the joint) or extra-articular (outside the joint).

In this article, surgeons from the NYU Hospital for Joint Diseases review the two most common causes of a stiff elbow. They present a brief overview of elbow anatomy. Treatment of elbow contractures is also described.

Trauma and heterotopic ossification (HO) are the most likely causes of elbow contractures. Elbow dislocations and damage to the nerves are the most common results of elbow trauma.

HO is the formation of calcified bone in the soft tissue. It is another potential consequence of elbow injury. But HO can also occur as a result of head injury, burns, and Paget's disease. Genetics may also play a role in HO. These are extra-articular conditions that do not occur directly in the elbow but affect the elbow.

Nonsurgical and surgical treatment are the main focus of the second half of this review. Nonoperative care is most successful when used within six months of an injury. Reducing inflammation and improving range of motion are very important.

Whenever possible, prevention is the main focus of management for elbow contracture. Exercise and splinting can help prevent loss of motion after trauma. Patients with known risk factors for HO should be treated prophylactically. This means treatment is given ahead of time to prevent the problem from ever occurring. Non-steroidal anti-inflammatory drugs (NSAIDS) and low-dose radiation are used as preventive agents most often.

Some patients may need surgery to restore elbow motion. Surgery can be done arthroscopically or with open release. Care must be taken to preserve and protect the ulnar nerve as it passes alongside the elbow.

In the case of HO, surgery can be done early and safely to remove the bone growth. With any elbow contracture, it may be necessary to cut the tendons or joint capsule in order to regain joint motion and function.

The surgeon takes a detailed history and performs a careful exam before deciding on the best plan of care. Lab values aren't helpful but X-rays and CT scans may be ordered. Satisfactory results of prevention and management of elbow contractures have been reported.

References: Mitchell T. Keschner, MD, and Nader Paksima, DO, MPH. The Stiff Elbow. In Bulletin of the NYU Hospital for Joint Diseases. Supplement 2, 2007. Vol. 65. Pp. 24-28.