-Cyprus Orthopaedics

Elbow Stiffness

Stiffness of the elbow leads to restriction of movements, which may impede function.
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Elbow Stiffness

Elbow stiffness, is a condition characterized by limited range of motion in the elbow joint. It can be caused by a variety of factors, including injury, overuse, or certain medical conditions. Elbow stiffness can significantly impact a person’s ability to perform everyday activities and can lead to chronic pain and discomfort.

Causes of Elbow Stiffness

There are several potential causes of elbow stiffness. One common cause is trauma or injury to the elbow joint, such as a fracture or dislocation. When the elbow is injured, the body’s natural response is to form scar tissue as part of the healing process. However, if the scar tissue becomes excessive or improperly formed, it can restrict the movement of the joint, resulting in stiffness.

Another cause of elbow stiffness is overuse or repetitive strain on the joint. This can occur in athletes or individuals who engage in activities that require repetitive elbow movements, such as throwing a baseball or swinging a tennis racket. The constant stress on the joint can lead to inflammation and the formation of scar tissue.

Certain medical conditions, such as arthritis or bursitis, can also contribute to elbow stiffness. Arthritis causes inflammation and degeneration of the joint, while bursitis involves inflammation of the fluid-filled sacs that cushion the joint. These conditions can result in pain, swelling, and limited mobility in the elbow.

Symptoms of Elbow Stiffness

The primary symptom of elbow stiffness is a limited range of motion in the joint. Individuals with elbow stiffness may find it difficult to fully extend or flex their arm, and may experience pain or discomfort when attempting to do so. Other common symptoms include swelling, tenderness, and a sensation of tightness in the joint.

In some cases, elbow stiffness may be accompanied by additional symptoms, such as weakness in the arm or hand, numbness or tingling, or difficulty performing everyday tasks, such as gripping objects or lifting weights. If you are experiencing any of these symptoms, it is important to consult with a healthcare professional for a proper diagnosis and treatment plan.

Diagnosis of elbow stiffness

To diagnose elbow stiffness, the orthopedist will typically begin by conducting a thorough physical examination of the affected joint. They will assess your range of motion, strength, and any areas of tenderness or swelling. They may also order additional diagnostic tests, such as X-rays or MRIs, to evaluate the underlying structures of the elbow joint.

These imaging tests can help identify any abnormalities or damage to the bones, ligaments, or tendons in the joint. In some cases, a joint aspiration may be performed, which involves removing a small sample of fluid from the joint for analysis. This can help rule out infection or other inflammatory conditions.

Treatment Options for Elbow Stiffness

The treatment approach for elbow stiffness will depend on the underlying cause and severity of the condition. In mild cases, conservative treatment methods may be sufficient to improve range of motion and alleviate symptoms. These may include:

  1. Physical Therapy: A physical therapist can design a customized exercise program to help improve flexibility and strength in the elbow joint. This may involve stretching exercises, strengthening exercises, and manual therapy techniques.
  2. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to help reduce pain and inflammation in the joint. In some cases, corticosteroid injections may be recommended to provide temporary relief.
  3. Splinting or Bracing: Wearing a splint or brace can help immobilize the elbow joint and promote healing. This may be particularly beneficial in cases where the joint is unstable or there is excessive scar tissue formation.

In more severe cases of elbow stiffness, surgical intervention may be necessary. Surgery can help remove scar tissue, repair damaged structures, or replace the joint entirely. Some common surgical procedures for elbow stiffness include:

  1. Arthroscopy: This minimally invasive procedure involves inserting a small camera into the joint to visualize and repair any damage. It can be used to remove scar tissue, repair ligaments, or address other structural issues.
  2. Open Surgery: In cases where the joint is severely damaged or cannot be effectively treated with arthroscopy, open surgery may be required. This involves making a larger incision to access and repair the joint.

Preventing and Managing Elbow Stiffness

While it may not always be possible to prevent elbow stiffness, there are steps you can take to reduce your risk and manage the condition:

  1. Warm-up and Stretching: Before engaging in any physical activity that involves repetitive elbow movements, it is important to warm up properly and perform stretching exercises to loosen the muscles and tendons.
  2. Avoid Overuse: If you regularly engage in activities that place excessive strain on the elbow joint, such as repetitive throwing or lifting, it is important to give yourself regular breaks and vary your movements to avoid overuse injuries.
  3. Maintain Proper Form: When participating in sports or activities that require repetitive elbow movements, make sure to use proper technique and form. This can help reduce the risk of injury and minimize stress on the joint.

Living with Elbow Stiffness: Tips and Advice

Living with elbow stiffness can be challenging, but there are strategies you can employ to manage the condition and improve your quality of life:

  1. Follow Your Treatment Plan: It is important to adhere to the treatment plan prescribed by your healthcare professional. This may include regular physical therapy sessions, taking medications as directed, and wearing any recommended splints or braces.
  2. Practice Self-care: Engaging in self-care activities, such as applying heat or cold therapy to the affected joint, practicing relaxation techniques, and getting enough rest, can help alleviate pain and promote healing.

Elbow stiffness may result from injury to the elbow such as fractures or dislocations or following surgery. In these cases the capsule or the sleeve of the joint becomes thickened and scarred as a consequence of the injury or surgery. Occasionally stiffness may occur from heterotopic ossification, a condition where excess bone forms and impedes movements. Stiffness may also occur due to arthritic conditions, which can not only cause thickening of the capsule but also bone spurs at the margins of the joint, which impinge and impede movements.  

Patients may experience difficulty reaching or in some instances pain at the end of the range of movements. Examination of the joint shows reduced movements when compared to the opposite side (if normal). An X-ray may be performed to look for loose bodies, bony spurs and to assess the joint surfaces. Special imaging with an MRI or CT scan may be necessary to look at the bearing surface and identify small bone spurs, which can impede movements.

If the symptoms are mild or infrequent, then no treatment may be necessary.

Physiotherapy: In patients with mild stiffness, physiotherapy directed towards stretching may be of benefit. Improvement occurs gradually over a period of 2-3 months.

Bracing: In patients with moderate to severe stiffness, particularly if the joint is not worn, the use of an external assist brace may be of benefit in improving the range of movements. The brace has to be worn using the prescribed regime and benefit may be seen over a period of 2-3 months. 

Surgery: In some patients, in whom symptoms are troublesome or interfere with sports or work, it may be appropriate to undertake surgical treatment.  In the absence of previous injuries or trauma, surgery consists of arthroscopy (“key-hole” surgery) to remove loose bodies and bone spurs as well as releasing the thickened and scarred capsule or “sleeve” of the joint. For further information on surgical treatment, please refer to the section on “Arthroscopic Treatment of Elbow Stiffness”.

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