Operative Treatment of Elbow Stiffness

![Figure][1] [Introduction][2] Open elbow contracture release is the mainstay for the operative treatment of posttraumatic elbow stiffness. [Step 1: Skin Incision][3] Use either a posterior skin incision and raise medial and lateral skin flaps or use more direct individual medial and lateral skin incisions. [Step 2: Protect or Release Peripheral Nerves][4] Release the ulnar nerve using a small incision and in situ release when a lateral muscle interval (between the extensor carpi radialis brevis and extensor digitorum communis muscles) is preferred for the contracture release; use a larger incision with subcutaneous anterior transposition when a medial muscle interval (50:50 split of the flexor pronator mass) is used. [Step 3: Develop Muscle Intervals for Exposure of the Joint][5] Choose a lateral (extensor carpi radialis brevis/extensor digitorum communis) or medial (50:50 split of the flexor pronator mass) muscle interval to expose the elbow capsule. ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] [Step 4: Resect Bone, Contracted Capsule, and Implants Restricting Motion][6] Remove the structures that hinder motion: implants, heterotopic bone, and contracted capsule. [Step 5: Tenolysis/Muscle Elevation][7] When the triceps and the brachialis muscles are adherent to the distal third of the humerus, release them using an elevator. [Step 6: Manipulate Elbow; Consider Implant Removal][8] Take care not to push so hard that you fracture the bone at a stress riser created by removal of bone or implants. [Step 7: Wound Closure][9] Close the muscle intervals and skin. [Step 8: Postoperative Management][10] The key after surgery is frequent, active, patient-assisted elbow flexion, extension, and forearm rotation stretches. [Results][11] A case series of patients with elbow contracture release documented an average improvement in the arc of elbow flexion of between 21° and 66°. [What to Watch For][12] [Indications][13] [Contraindications][14] [Pitfalls & Challenges][15] ![Figure][1] [Introduction][2] Open elbow contracture release is the mainstay for the operative treatment of posttraumatic elbow stiffness. [Step 1: Skin Incision][3] Use either a posterior skin incision and raise medial and lateral skin flaps or use more direct individual medial and lateral skin incisions. [Step 2: Protect or Release Peripheral Nerves][4] Release the ulnar nerve using a small incision and in situ release when a lateral muscle interval (between the extensor carpi radialis brevis and extensor digitorum communis muscles) is preferred for the contracture release; use a larger incision with subcutaneous anterior transposition when a medial muscle interval (50:50 split of the flexor pronator mass) is used. [Step 3: Develop Muscle Intervals for Exposure of the Joint][5] Choose a lateral (extensor carpi radialis brevis/extensor digitorum communis) or medial (50:50 split of the flexor pronator mass) muscle interval to expose the elbow capsule. ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] ![Figure][1] [Step 4: Resect Bone, Contracted Capsule, and Implants Restricting Motion][6] Remove the structures that hinder motion: implants, heterotopic bone, and contracted capsule. [Step 5: Tenolysis/Muscle Elevation][7] When the triceps and the brachialis muscles are adherent to the distal third of the humerus, release them using an elevator. [Step 6: Manipulate Elbow; Consider Implant Removal][8] Take care not to push so hard that you fracture the bone at a stress riser created by removal of bone or implants. [Step 7: Wound Closure][9] Close the muscle intervals and skin. [Step 8: Postoperative Management][10] The key after surgery is frequent, active, patient-assisted elbow flexion, extension, and forearm rotation stretches. [Results][11] A case series of patients with elbow contracture release documented an average improvement in the arc of elbow flexion of between 21° and 66°. [What to Watch For][12] [Indications][13] [Contraindications][14] [Pitfalls & Challenges][15] [1]: pending:yes [2]: #sec-12 [3]: #sec-13 [4]: #sec-14 [5]: #sec-15 [6]: #sec-16 [7]: #sec-17 [8]: #sec-18 [9]: #sec-19 [10]: #sec-20 [11]: #sec-21 [12]: #sec-22 [13]: #sec-23 [14]: #sec-24 [15]: #sec-25