When You Can’t Reach Due to a Stiff Elbow (Elbow Contracture)

• Inability to extend or flex the arm fully may not just be due to muscle contracture, but could also be due to a “stiff elbow”.
• The advantages of elbow arthroscopy are increased accuracy of treatment, smaller incisions, less pain and faster recovery.

You want to reach out to do something, but you’re unable to do so because your arm won’t extend as far as you intended. For example, you’re trying to pay your expressway fees to the employee in the booth. You stretch your arm… and yet you have to stretch even further just to barely reach far enough. Or maybe you do reach, but it feels like your arm is stretched so tight it could snap at any moment, causing immediate pain each time you try to use the affected arm. When this happens, many people tend to think that the problem is due to ramping or tightening of tendons in the arm. In reality the issue lies with the elbow itself and a condition known as “stiff elbow”.

The elbow serves to allow the hand and wrist to be extended out from your body, allowing you to reach, pick up or take hold of items placed away from your body. For example, the elbow allows you to extend your hand so that you can pay your expressway fees, reach items that are placed up on a high shelf, raise your arm to play badminton or tennis, etc. Those with elbow stiffness, however, will have a reduced or limited range of motion. As a result, their arms and hands will not be able to function normally in reaching out and away from the body.

Typically, for the average person, the range of motion for the flexion (bending) and extension (straightening) of the elbow joint begins with a small degree of flexion (5-10 degrees) and goes up to about 140 degrees flexion. Women generally tend to have slightly more range of motion than men. In cases of only minor loss of function, the elbow joint is still at a level whereby most normal activities can be carried out, such as typing, shopping, talking on the phone, using a screwdriver, turning a door handle, etc. If there is a loss of range of motion greater than the angles described above, this generally means a loss of function of the elbow. For some people, in addition to stiffness, there will also be symptoms of pain in the elbow joint as well. In these cases, patients will be unable to carry out their normal everyday functions, and should see a doctor for diagnosis and treatment.

Stiff elbows can be caused by a variety of factors, which can be either within the elbow joint itself (intrinsic) or in tissues surrounding the joint (extrinsic).

Intrinsic causes include problems with the articular surface of the joint, fragments of bone or cartilage that break free within the joint (loose bodies). Another intrinsic cause is pressure on a nerve in the elbow, or even chronic inflammation of the elbow joint, which could be due to an accident. In terms of causes not related to accidents, such as synovitis of the elbow, elbow stiffness may be a result of loose fragments of bone spurs that have broken off in the joint, or the growth of bone spurs that then block movement of the joint, thus causing infection as well as possible inflammation and thickening of the synovial membrane.

Extrinsic causes include muscle contracture, muscle scarring, ligament contracture or scarring. Other extrinsic causes are a previous elbow surgery due to a bone fracture, bone malunion or deformity, or surgery that required long-term use of fixation materials, such as using a cast or splint, leading to arthrofibrosis and thus stiffness of the elbow joint.

How to Conquer a Stiff Elbow
Factors used to determine the type of treatment depend on the patient’s age, occupation and the severity of the disease. Once the source or cause of the condition has been determined, treatment should be carried out accordingly. For example, if there is inflammation of the joints, the doctor may prescribe anti-inflammatory medication, reducing or stopping certain activities in order to reduce inflammation, or an injection into the joint to reduce inflammation. Alternatively, you may be advised to consult a doctor specialized in the specific disease causing the joint inflammation, in order to prevent elbow contracture.
For some patients, however, the condition may have already reached the point of elbow stiffness or contracture, and efforts to treat it using oral medications, injections and physical therapy have already failed. In cases like these, where other treatment steps have already been exhausted and have not been successful, surgery should be considered. Especially in cases where a clear cause has been determined, surgery can be particularly helpful in resuming the elbow’s normal use and range of motion.

It is widely known that nowadays there are two main types of surgery available for operations on joints — open surgery and arthroscopic surgery. Arthroscopic surgery, in addition to improved treatment results, also reduces injury or trauma to surrounding tissues when compared to traditional open surgery, which, by nature, affects and disturbs surrounding joint structures and tissues. The magnified view using the arthroscopy camera also allows the surgeon to see inside the joint much more clearly, enabling more accurate and precise treatment. It also means smaller incisions and less pain, which helps the postoperative treatment programs and physical therapy to yield better results, allowing patients to recover much more quickly as well.

Initial postoperative care should include medication for the reduction of swelling or inflammation. After this, treatment should focus on improving movement and range of motion. In some cases, medication to prevent buildup of calcium deposits in the muscles may be considered in order to avoid recurrence.

“Whether or not elbow stiffness will be recurrent or not depends on the pathology of the condition and on the patient’s body. Patient cooperation with postoperative care and treatment programs are very important. The good news is, the chances of recurrence are extremely low if the patient cooperates with the treatment and follows the doctor’s instructions very closely.”