Definition and Overview

An elbow joint contracture commonly occurs following burns, dislocations, and crush injuries. It can result in limited or total loss of motion that makes performing daily activities extremely difficult or even impossible for some patients.

In general, contractures are the result of constriction or stiffness of connective tissues. Aside from joints (such as the elbows), this can also affect the skin, ligaments, muscles, and tendons.

Causes of Condition

Aside from traumatic causes mentioned above, the contracture of the elbow joint can also occur as a result of congenital and acquired medical conditions, including:

  • Central nervous diseases including Parkinson’s disease, polio, and multiple sclerosis (MS), among others

  • Cerebral palsy

  • Congenital contractures

  • Congenital radial head dislocation

  • Hemophilia-associated hemarthroses

  • Muscular dystrophy

  • Osteoarthritis

  • Post-septic arthritis

  • Rheumatoid arthritis

Key Symptoms

The main symptom of the condition is the reduced ability to move the affected arm. This makes even simple activities, such as using a keyboard and getting dressed, extremely difficult.

Some patients also experience pain depending on the cause of the condition.

Who to See and Types of Treatments Available

Depending on the timing and severity of the condition, patients suffering from an elbow joint contracture may consult a physiotherapist or an orthopaedic specialist, a doctor who specialises in the diagnosis, treatment, and management of conditions that affect any part of the musculoskeletal system including the joints.

Protocols in diagnosing the condition involve conducting a thorough evaluation of the patient’s medical history and x-ray results. If more details are needed to confirm a diagnosis, computed tomography (CT) scan, may be performed.

Conservative treatments are generally recommended in patients suffering from minimal contractures. This often involves physical and occupational therapists who can perform the following procedures:

  • Mobilising splinting - This method involves holding the affected joints at the end of the available range of motion for an extended period. This is proven effective in restoring passive motion to stiff joints and muscles.

  • Serial casting - This involves the application and removal of a series of lightweight fiberglass casts to stretch shortened or tight muscles. It is referred to as serial casting because each time a new cast is applied, the position of the body changes. Its goal is to gradually increase the joint's flexibility.

  • Manual manipulation - Also referred to as manual therapy, this involves the manual manipulation of joint under anaesthetics. It can be performed by physical, massage, or occupational therapists as well as osteopaths and osteopathic physicians. In some cases, it is performed using anaesthetics.

  • Botulinum toxin (BT) A injections - BT injections can be combined with physical therapy to further improve treatment outcomes. It works by relaxing the affected joint and by reducing tension and spasms.

If non-surgical therapies and corrective splinting have failed to provide symptoms relief, surgical release is recommended. This is especially indicated for patients who have lost a functional arc of motion for daily activities. The procedure can be performed through a small incision on the elbow (arthroscopically), a method that minimises postsurgical complications and reduces recovery time. Depending on patient-specific circumstances, surgeons may elect to sedate the patient or perform the procedure under general anaesthesia. During surgery, all thickened and abnormal scar tissue are removed, which can immediately restore the patient’s range of motion. Nerves are also decompressed while normal elbow ligaments are preserved.

Patients who have undergone surgical release must undergo physical therapy right away. They are also taught specific exercises while they are recovering at home and are advised to use continuous passive motion (CPM) machine to speed up their recovery.

References:

  • Dodds SD, Hanel DP. Heterotopic ossification of the elbow. In: Trumble T, Budoff J, eds. Wrist and Elbow Reconstruction and Arthroscopy, A Masters Skills Publication. Rosemont: American Society for Surgery of the Hand; 2006:425–437.

  • Monument MJ, Hart DA, Befus AD, et al. The mast cell stabilizer Ketotifen fumarate lessens contracture severity and myofibroblast hyperplasia: A study of a rabbit model and posttraumatic joint contractures. J Bone and Joint Surgery. 2010; 92(A): 1468–1477.

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