Management of the stiff elbow

Stiffness of the elbow is a relatively common problem that can result in disability. The elbow is prone to stiffness after injury or surgery and there is limited scope for compensatory motion in the shoulder and wrist. Despite advances in knowledge of the pathogenesis of elbow contractures and the development of new treatment regimens, elbow stiffness remains a challenging problem. To regain functional elbow motion several non-operative and operative treatments are available. Non-operative treatment modalities consist of static and dynamic splinting, both having comparable results and a low risk of complications. Surgical release is performed open or arthroscopically, depending on the severity of the contracture, the presence of concomitant pathology of the ulnar nerve and osseous deformity, as well as the surgeon's preference. The open lateral column procedure has been the gold standard for a number of years. With the increasing popularity and experience of arthroscopy, a shift is seen towards arthroscopic capsular release for some indications. Outcomes of both techniques are largely comparable, with low complication rates, although the rate of complications increases with the extent of the surgical procedure. With regard to the rehabilitation programme after surgical release, different protocols are used in different hospitals and countries and may include extensive physical therapy with or without the use of continuous passive motion. The current recommendation is to continue postoperative rehabilitation as long as the range of motion is improving and until no further increase is expected. The aim of this article is to provide an overview of the aetiology, treatment, rehabilitation options and outcome of elbow stiffness. Current treatment options are discussed and future perspectives are provided.