Elbow Contracture M24.529 718.42

ICD-9	Classification / Treatment
Etiology / Natural History	Associated Injuries / Differential Diagnosis
Anatomy	Complications
Clinical Evaluation	Follow-up Care
Xray / Diagnositc Tests	Review References

synonyms: elbow stiffness, elbow contracture, frozen elbow

<1 yrs duration = stretching exercises, dynamic splinting, and adjustable static night splints
surgical release for contracture >30 degrees that has failed non-op management. Results of surgical relase for contracture <30 degrees is unpredictable
Anterior capsulectomy and CPM (Gates HS III, JBJS 74A;1229;1992)

Elbow Contracture ICD-9

Elbow Contracture Etiology / Epidemiology / Natural History

Loss of terminal extension is typically well tolerated, except in gymnasts and basketball players. Loss of flexion affects Activities of Daily Living and is not well tolerated.

Elbow Contracture Anatomy

Functional elbow ROM: Flex/extend 30° -130° , pronatation = 50° , supination = 50° (Morrey BF, JBJS 63A;872:1981).

Elbow Contracture Clinical Evaluation

Elbow Contracture Xray / Diagnositc Tests

Elbow Contracture Classification / Treatment

Initial Treatment: physical therapy with static progressive splinting. (Doornberg JN, JOT 2006;20:400)(link is external).
Arthroscopic release (Nguyen D, Arthroscopy 2006;22:842)(link is external) (Ball CM, JSES 2002;11:624)(link is external),
-See Elbow Arthroscopy
-Anterior capsule is release with a blunt-tipped obturator using a sweeping motion from distal to proximal to increase the joint space.
-Synovial is debrided with shaver, always keep shaver directed toward bone, minimize use of suction.
-Sharp capsular release is then perform using an arthroscopic bitter from lateral to medial.
-Capsule debrided with shaver.
-Gentle manipulation should then allow full extension. Consider viewing form lateral portal to ensure anteromeidal capsule was released. Record post-operative motion.
Open capsular release 24006 (Marti RK, Acta Orthop Scand 2002;73:144). (Tan V, J Trauma 2006;61:673)(link is external).
Consider prophylactic ulnar nerve decompression or transposition in patients with 90°-100° flexion deficits, to decrease risks of post-operative ulnar neuropathy.

Elbow Contracture Associated Injuries / Differential Diagnosis

Elbow Contracture Complications

Elbow Contracture Follow-up Care

Post-op: place in extension with an anterior splint to maintain maximum extension for 24-48 hours.
2 Days: Splint removed. Evaluate ROM. Start active and active assisted ROM with goals of full flexion/extension, supination/pronation.
2 Weeks: Evaluate ROM/Progress.
3Weeks: Evaluate ROM. Consider manipulation under anesthesia if motion is not continueing to improve significantly. Consider static progressive splinting.

Elbow Contracture Review References