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Degenerative Condition

Elbow Stiffness

Elbow Contracture & Loss of Motion

Understanding causes and treatment of elbow stiffness - from therapy to surgical release

Understanding Elbow Stiffness

The elbow is particularly prone to stiffness following injury due to the tight congruency of the joint and the tendency of the capsule to contract. Even brief periods of immobilization can result in significant loss of motion.

Functional Arc (Morrey)

Flexion-Extension Arc

30° to 130° of flexion

Required for most daily activities

Forearm Rotation Arc

50° pronation to 50° supination

Essential for hand positioning

Morrey Classification

Extrinsic Causes

Capsular contracture - most common

Heterotopic ossification - bone in soft tissue

Skin contracture - burns, scarring

Muscle/tendon shortening

Collateral ligament contracture

Intrinsic Causes

Articular incongruity - malunion

Loose bodies - cartilage/bone fragments

Osteophytes - bone spurs

Synovitis - inflammatory

Arthrosis - joint surface damage

Note: Most post-traumatic stiffness involves both intrinsic and extrinsic components. Thorough preoperative assessment with CT scan is essential for surgical planning.

Causes & Risk Factors

Common Causes

Elbow fractures (especially intra-articular)
Elbow dislocations
Prolonged immobilization
Severe soft tissue injury
Burns around the elbow
Inflammatory arthritis

Risk Factors for HO

Head injury or traumatic brain injury
Severe burns
High-energy trauma
Delay in treatment
Multiple surgical procedures
Previous history of HO

Treatment Options

Conservative Treatment

Physical Therapy

Active and passive range of motion exercises, stretching program

Serial Static Progressive Splinting

Low-load, prolonged stretch using adjustable splints. Patient advances splint as tolerated. 6-8 hours daily wear.

Dynamic Splinting

Spring-loaded splints that provide continuous gentle stretch

Turnbuckle Splints

Adjustable splints for more aggressive stretching when tolerated

Continue conservative treatment for at least 6 months before considering surgery (unless HO fully mature)

Surgical Treatment

Indicated when conservative treatment plateaus and functional limitations persist

Arthroscopic Capsular Release

Minimally invasive release of contracted capsule. Best for extrinsic stiffness without significant bony block.

Open Capsular Release

Lateral (Kocher/Column) or medial approach for extensive contracture. Allows better visualization and removal of heterotopic bone.

HO Excision

Wait until HO is "mature" (typically 12-18 months post-injury, confirmed by normal alkaline phosphatase or bone scan). Prophylaxis with indomethacin or single-dose radiation post-op.

Post-operative Protocol

  • • Continuous passive motion (CPM) machine - start immediately
  • • Aggressive physical therapy within 24-48 hours
  • • Static progressive splinting program
  • • HO prophylaxis if indicated (indomethacin 75mg x 6 weeks)

Evidence & References

• Morrey BF. Post-traumatic contracture of the elbow: operative treatment including distraction arthroplasty. JBJS Am 1990

• Lindenhovius AL, Jupiter JB. The posttraumatic stiff elbow: a review of the literature. JBJS Am 2007

• Aldridge JM 3rd, et al. Results of arthroscopic treatment of the stiff elbow. J Hand Surg Am 2004

• Ring D, Jupiter JB. Operative release of complete ankylosis of the elbow due to heterotopic bone. JBJS Am 2003

Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)

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