The stiff elbow: Current concepts.

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Abstract

Conflict of interest statement: Conflict of interest: The authors declare no potential conflict of interest. 11. EFORT Open Rev. 2023 Aug 1;8(8):651-661. doi: 10.1530/EOR-22-0118. How to treat stiffness after proximal humeral fractures? Rojas JT(1)(2), Rashid MS(3), Zumstein MA(1)(4)(5)(6). Author information: (1)Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopädie Sonnenhof, Bern, Switzerland. (2)Department of Orthopaedics and Trauma Surgery, Hospital San José - Clínica Santa María, Santiago, Chile. (3)Department of Trauma & Orthopaedic Surgery, Wrightington Hospital, Wigan, United Kingdom. (4)Shoulder, Elbow Unit, Sportsclinicnumber1, Bern, Switzerland. (5)Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland. (6)Campus Stiftung Lindenhof Bern, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland. Shoulder stiffness is a frequent complication after proximal humeral fractures treated with or without surgery. Shoulder stiffness is associated with high rates of absence from work and a significant financial burden for the healthcare system. Secondary stiffness is characterized by additional extracapsular adhesions, including subacromial, subcoracoid, and subdeltoid spaces, usually derived from post-fracture or post-surgical extraarticular hematomas. Several secondary causes may coexist with capsular and extracapsular adhesions decreasing the shoulder motion, such as malunion, nonunion, metalwork failure, infection, and osteoarthritis, among others. Conservative treatment, usually prescribed for primary shoulder stiffness, has shown unfavorable results in secondary stiffness, and surgical intervention may be required. Surgical interventions need to be patient-specific. Usually, open or arthroscopic fibro-arthrolysis and subacromial release are performed, together with plate removal and biceps tenotomy/tenodesis. In severe osteoarthritis, shoulder replacement may be indicated. Ruling out infection is recommended in every case. DOI: 10.1530/EOR-22-0118 PMCID: PMC10441249