Posttraumatic Elbow Contracture

Gregory Rafijah

Disclosures

Curr Orthop Pract. 2014;25(3):213-216. 

In This Article

Arthroscopic Contracture Release of the Elbow

Elbow contracture can be corrected arthroscopically in mild cases of posttraumatic disease. Arthroscopic treatment can focus on intrinsic causes of elbow stiffness such as removal of loose bodies, debridement of osteophytes, and capsular release. However, since extrinsic causes of stiffness cannot be treated with arthroscopy, there is limited value to arthroscopic debridement in the posttraumatic setting. There is also greater risk of neurovascular injury when using arthroscopy in a previously scarred elbow. Scarring from trauma results in tethering of nerves in scar tissue that may increase the risk of iatrogenic injury. Additionally, scarring of the joint capsule results in decreased compliance and a smaller joint volume. As a result, there may not be adequate capsular distension to safely displace nerves away from the working space within the joint which increases the risk of nerve injury.[14]

However, mild contractures that are 301 or less may benefit from arthroscopic release provided that the surgeon is very experienced with elbow arthroscopy.[15] The risk of neurovascular injury may be reduced with a safety-driven strategy of getting an established view, creation of adequate working space, bone removal, and finally capsulectomy. Blonna et al.[16] reported no permanent nerve injuries in 502 arthroscopic elbow contracture releases after this safety driven standard sequence of surgical events during elbow arthroscopy.

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