Effective Treatments for Elbow Joint Stiffness After Fracture

Q: Effective Treatments for Elbow Joint Stiffness After Fracture

Hello： In response to your question, there are several treatment options for nonunion fractures： First, electrical stimulation, which is currently used infrequently and may not always be effective. <br>Second, ultrasound stimulation, with various manufacturers offering both large

Elbow joint stiffness?

Hello Director Li, I apologize for disturbing you.
You experienced a car accident on March 8, 2003, which resulted in a comminuted fracture of the ulnar bone in your left elbow.
After an emergency surgery, internal fixation was performed using steel pins, which were removed on June 9 of the same year.
However, the fracture site did not heal, and you developed stiffness in the elbow joint with the olecranon involved.
Due to the non-union of the bone, a bone grafting surgery was performed, but the elbow joint remains stiff with a flexion angle of less than 50 degrees (60-110).
Could you please let me know if there are any more effective options, such as surgical methods, in addition to rehabilitation? Thank you very much for your time and assistance.

KK, 20~29 year old female. Ask Date: 2004/09/03

Dr. Li Wenlin reply Orthopedics

Hello: In response to your question, there are several treatment options for nonunion fractures: First, electrical stimulation, which is currently used infrequently and may not always be effective.
Second, ultrasound stimulation, with various manufacturers offering both large and small devices, some of which can be used at home, making it quite convenient.
Third, shockwave therapy, initially used for conditions like plantar fasciitis and tennis elbow, has also shown remarkable results for nonunion fractures.
These are non-invasive treatments.

Invasive treatments involve surgical options, which include several methods: the first is the injection of bone marrow aspirate or synthetic bone grafts; the second is bone grafting surgery, which may require modifications to the original fixation method (whether to replace plates, intramedullary nails, or screws).

Regarding joint stiffness, rehabilitation is indeed the best approach.
However, if specific factors such as adhesions or nonunion are present, special treatment methods may be necessary, such as joint mobilization under local or regional anesthesia or surgical interventions (such as arthroscopic release or adhesiolysis).
The timing and selection of these special treatments should be based on individual case circumstances.
It is advisable to consult a nearby orthopedic specialist for accurate recommendations based on your situation.
Wishing you a speedy recovery.

Reply Date: 2004/09/03

More Info

Elbow joint stiffness following a fracture can be a significant challenge for patients, particularly after complex injuries such as a comminuted fracture of the ulna. In your case, the history of multiple surgeries, including internal fixation and subsequent bone grafting due to nonunion, indicates a complicated recovery process. The stiffness you are experiencing, with a flexion range of less than 50 degrees, is not uncommon in such scenarios.

Understanding Elbow Stiffness
Elbow stiffness can arise from several factors, including:
1. Scar Tissue Formation: Following surgery, scar tissue can develop around the joint, limiting movement.

2. Joint Capsule Tightening: The joint capsule may become tight and restrict motion.

3. Muscle Weakness: After prolonged immobilization, the muscles around the elbow may weaken, contributing to stiffness.

4. Pain: Pain can inhibit movement, leading to a cycle of stiffness.

Treatment Options
1. Physical Therapy: This is often the first line of treatment. A physical therapist can provide a tailored rehabilitation program that includes:
- Range of Motion Exercises: Gentle stretching and mobilization techniques can help improve flexibility.

- Strengthening Exercises: Once some range of motion is regained, strengthening the muscles around the elbow is crucial.

- Manual Therapy: Techniques such as joint mobilization can be beneficial.

2. Continuous Passive Motion (CPM) Machines: These devices can be used postoperatively or during rehabilitation to help maintain joint mobility without requiring active effort from the patient.

3. Injections: Corticosteroid injections may help reduce inflammation and pain, potentially allowing for increased range of motion during therapy.

4. Surgical Options:
- Arthroscopic Release: If conservative measures fail, arthroscopy can be performed to remove scar tissue and adhesions around the joint, which may improve range of motion.

- Open Surgery: In cases of severe stiffness, an open surgical procedure may be necessary to release the joint capsule or to perform a contracture release.

- Osteotomy: In some cases, realigning the bones may be necessary to restore function.

5. Joint Mobilization Techniques: These can be performed by a trained therapist or physician to help improve joint movement.

Prognosis and Expectations
The prognosis for elbow stiffness after a fracture can vary widely based on several factors, including the severity of the initial injury, the quality of the surgical repair, and adherence to rehabilitation protocols. Generally, with appropriate treatment, many patients can regain a functional range of motion, although full recovery may take time.

Recommendations
- Consult with an Orthopedic Surgeon: Given your history of nonunion and persistent stiffness, it may be beneficial to seek a second opinion from an orthopedic surgeon specializing in elbow injuries. They can assess your current condition and discuss the potential for surgical intervention if conservative measures are insufficient.

- Adhere to Rehabilitation Protocols: Consistency in physical therapy is key. Ensure you are following the prescribed exercises and attending therapy sessions regularly.

- Monitor Pain Levels: If pain is a significant barrier to movement, discuss pain management strategies with your healthcare provider.

In conclusion, while rehabilitation is crucial, there are additional surgical options available if conservative treatments do not yield the desired results. It is essential to have open communication with your healthcare team to explore all possible avenues for improving your elbow function.

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