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Elbow Contracture M24.529 718.42

elbow bones lateral view

elbow medial view

elbow cross sectional anatomy

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-10

Elbow Contracture ICD-9

  • 718.42 (elbow contracture)

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

  • Complain of pain and limited ROM
  • Document ulnar nerve function.
  • Note any prior incisions or skin grafts(burns)

Elbow Contracture Xray / Diagnositc Tests

Elbow Contracture Classification / Treatment

  • Initial Treatment: physical therapy with static progressive splinting. (Doornberg JN, JOT 2006;20:400).
  • Arthroscopic release (Nguyen D, Arthroscopy 2006;22:842) (Ball CM, JSES 2002;11:624),
    -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).
  • 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

  • Continued stiffness
  • Ulnar nerve palsy

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