Stiff Elbow: Foundational Concepts and Causes
Definition: Elbow stiffness is a reduction in the functional arc of flexion and extension, with or without loss of pronation and supination. Clinically important stiffness is usually present when the elbow cannot provide the arc required for activities of daily living. A commonly accepted functional flexion-extension arc is approximately 30° to 130°, with a forearm rotation arc of about 50° pronation to 50° supination; however, individual functional requirements vary. Loss of extension is often better tolerated than loss of flexion, whereas loss of forearm rotation markedly affects hand positioning.
Post-traumatic elbow stiffness is particularly common because the elbow is a highly congruent joint with a close-fitting capsule, substantial collateral ligaments, and a tendency to develop haemarthrosis, capsular fibrosis and heterotopic ossification after injury or immobilisation. The final restriction may be due to a single lesion or a combination of osseous, capsular, muscular and neurological factors.
a) Causes of Stiff Elbow
Enumeration
- Post-traumatic causes: fractures, dislocations, fracture-dislocations, intra-articular incongruity, malunion, non-union and prolonged immobilisation.
- Degenerative and inflammatory arthropathies: osteoarthritis, rheumatoid arthritis, haemophilic arthropathy, septic arthritis and tuberculous arthritis.
- Congenital and developmental causes: congenital radioulnar synostosis, congenital dislocation of the radial head and skeletal dysplasias.
- Heterotopic…