THE PAINFUL STIFF ELBOWDR MANISH GUPTA

SPECIALIST SURGEON

SHOULDER ELBOW WRIST

anatomy & function

the elbow changes the radius of the sphere of reach of the hand

need an arc of 30-130 degrees

flexion <120 exceeds positional adaptation of neck shoulder and wrist

prono-supination arc 100 degrees

highly congruent system of 3 joints within a single synovial cavity

close relationship of the joint to its ligaments and muscles

causes and classification of stiffness

intrinsicarticular malalignment/

incongruity

loss of articular cartilage

loose bodies

extrinsiccapsule/ ligaments

heterotopic ossification

mixed

primary

men, heavy exposure

early- end range impingement, late- pain through mid range

secondary

even trivial pathologies can lead to stiffness

5% of simple dislocations lead to functional stiffness

clinical assessmentpain at end range- osteophyte impingement

pain mid range- severe joint degeneration, or joint incongruence

pain with forearm rotation-radial head involvement

locking/ catching- loose bodies

ulnar nerve

shoulder

functional enquiry

lifting things at homecarrying shopping washing and hygienedressing

sleep disturbance

work & everyday activities

leisure and recreation

imaging

x-ray usually sufficientgrade 1: ulnotrochlear

involvementgrade2: ulnotrochlear

and radiocapitellar grade 3: radiocapitellar

subluxation

maturity of heterotopic ossification

CT scan

(nerve conduction testing/ EMG)

goals of treatment

increase range of motion

without increasing pain and

without creating instability

non surgical treatment

splints

serial casting

physiotherapy

effective for extrinsic

soft tissue

causes of stiffness

surgery?

non operative treatment failed or not indicated

soft tissue equilibrium

options

arthroscopy

open debridement/ release

interposition +- ligament reconstruction

total replacement arthroplasty

arthroscopysimple stiffness

mild/moderate loss of movement

minimal previous surgery

includes primary osteoarthritis, OCD, rheumatoid

open debridement

“column procedure”

open debridement

“medial over the top procedure”

interposition

dynamic external fixation+- ligament reconstruction

total elbow replacement

patient

younger active older low demand

simple stiffness complex stiffness

arthroscopy

joint congruent joint incongruent/ severe degeneration

total elbow replacement

column procedure interposition +- ligament reconstruction dynamic external fixation

column procedure

Dr Manish Guptashoulder elbow wrist specialist

tel: 9687 8344email: reception@mgorthopaedics.com.au

web: www.mgorthopaedics.com.au