What is the pathology of stiffness of the elbow?
Elbow stiffness may result from injury to the elbow such as fractures or dislocations or following surgery. In these cases the capsule or the sleeve of the joint becomes thickened and scarred as a consequence of the injury or surgery. Occasionally stiffness may occur from heterotopic ossification, a condition where excess bone forms and impedes movements. Stiffness may also occur due to arthritic conditions, which can not only cause thickening of the capsule but also bone spurs at the margins of the joint, which impinge and impede movements.
How is stiffness of the elbow diagnosed?
Patients may experience difficulty reaching or in some instances pain at the end of the range of movements. Examination of the joint shows reduced movements when compared to the opposite side (if normal). An X-ray may be performed to look for loose bodies, bony spurs and to assess the joint surfaces. Special imaging with an MRI or CT scan may be necessary to look at the bearing surface and identify small bone spurs, which can impede movements.
How is stiffness of the elbow treated?
If the symptoms are mild or infrequent, then no treatment may be necessary.
Physiotherapy: In patients with mild stiffness, physiotherapy directed towards stretching may be of benefit. Improvement occurs gradually over a period of some months. The British Elbow and Shoulder Society (BESS) website has useful videos on exercises for elbow stiffness.
Bracing: In patients with moderate to severe stiffness, particularly if the joint is not worn, the use of an external assist brace may be of benefit in improving the range of movements. The brace has to be worn using the prescribed regime and benefit may be seen over a period of 2-3 months.
Surgery: In some patients, in whom symptoms are troublesome or interfere with sports or work, it may be appropriate to undertake surgical treatment. In the absence of previous injuries or trauma, surgery consists of arthroscopy (“key-hole” surgery) to remove loose bodies and bone spurs as well as releasing the thickened and scarred capsule or “sleeve” of the joint. For further information on surgical treatment, please refer to the section on “Arthroscopic Treatment of Elbow Stiffness”.