Stiffness of the elbow

NGÔ KIỀU MINH ĐẠT REVIEW  ANATOMY  ROM ( RANGE OF MOTION) Measurement of Flexion/Extension Measurement of Pronation-Supination Introduction  Morrey et al found the functional arc of elbow motion during activities of daily living to be 100° for both flexion–extension (30° to 130°) and pronation– supination (50° in either direction)  Although functional limitations can be seen with less severe loss of motion, a stiff elbow has been defined as one with loss of extension of greater than 30° and flexion of less than 120° Sojbjerg JO Acta Orthop Scand 1996 Dec; 67(6):626-31 Treatment Nonsurgical  Physical therapy (active and passive ROM), nonsteroidal anti-inflammatory drugs  Splinting/ROM regimen Dynamic Progressive static stretch Turnbuckle (adjustable static type) 20-hour program, alternate flexion/extension Dynamic elbow splint Static progressive elbow splint Surgical Indications  extrinsic contractures  some contractures of intrinsic origin, such as osteoarthritis  Failed nonsurgical course of treatment  Patient compliant with postoperative therapy  Heterotopic ossification can be resected once it is mature Contraindications  Intra-articular ankylosed elbow  Neurologic elbow disorder  Charcot elbow  Deficient skin envelope—May need rotational flap  Posttraumatic arthritis—Surgical release is rarely indicated for contractures