Sticking Up for the Best Position in a Stuck Elbow

If your elbow needed to be fused in one position, what's the best position to choose? A group of researchers asked that question. They studied different elbow positions in healthy volunteers. Each person bent his elbow to a different angle. Then a brace was strapped on, locking the elbow in place. The researchers took measurements to see which elbow position allowed the most function. Activities such as brushing the teeth, reading the newspaper, using a telephone, and drinking water from a cup were evaluated.

Fortunately, fusion surgery to lock the elbow in one position (called arthrodesis) isn't required very often. This operation may be a final effort to help with some unusual medical condition or save a damaged elbow joint. Without use of the elbow, daily activities can be severely limited. Until now, the best position for elbow arthrodesis wasn't known. Most reports suggest 90 degrees (elbow bent to form a right angle), but no data have proven that this position is best.

Other positions have been recommended, but it's uncertain whether they're good for the whole arm. These researchers wanted to know which elbow position would allow the best use of the whole arm for personal hygiene and daily activities. The researchers examined how much elbow motion was needed for each task and how much of each task could be done in each elbow position.

Twenty-four healthy adult volunteers were observed with the elbow locked in six different positions. The best position was 110 degrees of flexion, or slightly more than a right angle. All but three members of the study could complete all tasks with the elbow in this position.

There is no perfect position for an elbow fusion because the arm does a wide range of activities. Some activities require more bend in the elbow (drinking, brushing the teeth). Others need a straight elbow (putting on shoes, reaching objects). The position for elbow arthrodesis should also take into consideration the patient's age, occupation, and preferences. Whether the person is right- or left-handed is also important. Before surgery, it is recommended that the patient try an adjustable brace to see what works best at home and on the job.

References: Chris Tang, MD, et al. The Effect of Simulated Elbow Arthrodesis on the Ability to Perform Activities of Daily Living. In The Journal of Hand Surgery. November 2001. Vol. 26A. No. 6. Pp. 1146-1150.