Stiff Elbow
The elbow is a hinged complex joint made up of three bones, the humerus, ulna and radius. The ends of the bones are covered with cartilage. Cartilage has a rubbery consistency that allows the joints to slide easily against one another and absorb shock. The bones are held together with ligaments that form the joint capsule. The joint capsule is a fluid filled sac that surrounds and lubricates the joint.
Why does elbow become stiff?
Stiffness of elbow can be because of soft tissue contracture or bony abnormality which blocks the movements.
- Post traumatic Arthritis or Mal union
- Primary Arthritis
- Inflammatory Arthritis
- Infection
- Post Surgical
- Abnormal bony structure.
Symptoms:
- Pain: Especially with lifting and loading the arm. There may also be aching sensation in forearm with tingling and numbness in the ring and little fingers. Progressively may get pain at night
- Locking and clicking / clunking sensation in elbow, may or may not be associated with pain.
- Stiffness of elbow – as the arthritis progresses the elbow may become stiff and cause problems with activities of daily living
- Pins and needles and numbness in ulnar nerve distribution in hand. May be associated with clumsiness in fingers when doing fine motor activities ie doing buttons, holding small change etc.
Diagnosis:
The diagnosis of elbow stiffness is based on careful history and clinical examination.
Investigations:
Usually a plain X-Ray is needed to look at the anatomy of the elbow, but further investigations in form of CT, MRI or Ultrasound scans may be required before surgery.
Treatment:
- For the early stages of osteoarthritis of the elbow, the most common treatment is nonsurgical. This includes oral medications to reduce or alleviate pain, rest and activity modification.
- Physical therapy may be helpful in early stages when the symptoms are mild.
- Corticosteroid injections are sometimes used to treat osteoarthritis symptoms. The effects of injections are temporary, they can provide significant pain relief until symptoms progress enough to need additional treatment.
Elbow Arthroscopy / Key Hole Surgery
- For patients who are not improving with therapy, the surgeon can release the contracture and smooth out the joint surface. Arthroscopy has been shown to provide symptom improvement at least in the short term. It involves removing any loose bodies or inflammatory/degenerative tissue in the joint. It also attempts to smooth out irregular surfaces. It can be done as a day case procedure, and recovery is reasonably rapid.
- Open Release:
Some cases may not be suitable for key hole surgery and in those cases open surgery either by single or two incisions may be necessary.