Mentoring Minutes: Elbow Stiffness

References & Notes

Filh GM, Galvão MV. POST-TRAUMATIC STIFFNESS OF THE ELBOW. Revista Brasileira de Ortopedia. 2010;45(4):347-354. doi:10.1016/S2255-4971(15)30380-3.

- stiff elbows presented a thin capsule with a disorganized collagen matrix, increased inflammatory cytokine levels and fibroblastic infiltration, thus characterizing a fibrotic and inflammatory condition

- combination of loss of extension associated with loss of forearm supination represents a severe limitation on certain activities 

- functional arc of the elbow is defined as a range of flexion-extension motion of 30° to 130° and pronosupination of 50° to –50. (10)On the other hand, loss of 50% of the mobility of the elbow represents a functional loss of 80% of limb function. Likewise, contracture of flexion greater than 45° gives rise to severe dysfunction regarding the capacity to position the hand in space

-treatment: mobs, stretches, and splints

Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Rehabilitation of the Overhead Athlete’s Elbow. Sports Health. 2012;4(5):404-414. doi:10.1177/1941738112455006.

- if the patient continues to have difficulty achieving full extension using ROM and mobilization techniques, a low-load, long-duration (LLLD) stretch may be performed to produce a deformation (creep) of the collagen tissue, resulting in tissue elongation.

- The patient lies supine with a towel roll or a foam pad placed under the distal brachium to act as a cushion and fulcrum. Light-resistance exercise tubing is applied to the wrist of the patient and secured to the table or a dumbbell on the ground (Figure 1). The patient is instructed to relax as much as possible for 10 to 15 minutes per treatment. The resistance applied should enable the patient to stretch for the entire duration without pain or muscle spasm. This technique is intended to impart a low load during a long-duration stretch. Patients are instructed to perform the LLLD stretches several times per day, totaling at least 60 minutes of total end range time. We typically recommend a 15-minute stretch, 4 times per day. This program has been referred to as a TERT program (total end range time)

- Open pack:

            - HU joint: 70 deg flexion, 10 deg supination

                        - Distraction treatment

            - HJ joint: Full ext and supination

                        -Radial treaction treatment

                        - Post glide for ext

                        - Ant glide for flexion

            - PRU joint: 70 deg flexion, 35 deg supination

                        - post glide for pronation

                        - Ant glide for supination

A prospective randomized control Trial of dynamic versus static progressive elbow splinting for posttraumatic elbow stiffness. JBJS. 2012:94 694-700