scholarly journals The stiff elbow: Current concepts

2020 ◽  
Author(s):  
Giulia Masci ◽  
Gianpiero Cazzato ◽  
Giuseppe Milano ◽  
Gianluca Ciolli ◽  
Giuseppe Malerba ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Continuous Passive Motion ◽  
Anatomical Location ◽  
Tissue Elasticity ◽  
Elbow Stiffness ◽  
Granulation Tissue Formation ◽  
Stiff Elbow ◽  
The Stability ◽  
Surgical Drain ◽  
Degree Of Severity

Elbow stiffness is defined as any loss of movement that is greater than 30° in extension and less than 120° in flexion. Causes of elbow stiffness can be classified as traumatic or atraumatic and as congenital or acquired. Any alteration affecting the stability elements of the elbow can lead to a reduction in the arc of movement. The classification is based on the specific structures involved (Kay’s classification), anatomical location (Morrey’s classification), or on the degree of severity of rigidity (Vidal’s classification). Diagnosis is the result of a combination of medical history, physical examination (evaluating both active and passive movements), and imaging. The loss of soft tissue elasticity could be the result of bleeding, edema, granulation tissue formation, and fibrosis. Preventive measures include immobilization in extension, use of post-surgical drain, elastic compression bandage and continuous passive motion. Conservative treatment is used when elbow stiffness has been present for less than six months and consists of the use of serial casts, static or dynamic splints, CPM, physical therapy, manipulations and functional re-education. If conservative treatment fails or is not indicated, surgery is performed. Extrinsic rigidity cases are usually managed with an open or arthroscopic release, while those that are due to intrinsic causes can be managed with arthroplasties. The elbow is a joint that is particularly prone to developing stiffness due to its anatomical and biomechanical complexity, therefore the treatment of this pathology represents a challenge for the physiotherapist and the surgeon alike.

scholarly journals Zdravljenje zmanjšane gibljivosti komolca

2018 ◽  
Vol 87 (5-6) ◽  
Author(s):  
Anže Mihelič ◽  
Maruška Trebše ◽  
Neža Trebše ◽  
Rihard Trebše
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Open Surgery ◽  
Surgical Approaches ◽  
Anatomical Location ◽  
Nerve Lesion ◽  
Elbow Stiffness ◽  
Arthroscopic Release ◽  
Bony Impingement ◽  
Nerve Release

Elbow stiffness may develop due to various causes but most frequently it is secondary to a traumatic elbow lesion or heterotopic ossification common after head or spinal trauma. Both open and arthroscopic releases are effective. The arthroscopic release is reserved for intra-articular and capsular reasons, while open surgery can address either intra-articular or extra-articular causes. Different surgical approaches are used to treat elbow stiffness, depending on the exact anatomical location of the lesion that limits the range of movements. Complications are rare, the most frequent being incomplete resolution of stiffness. Nerve lesions are very rare. Most frequent is a partial ulnar nerve lesion, especially when nerve release or transposition is required. Conservative treatment with static or dynamic braces can be effective when there are no anatomical reasons for stiffness. Braces can be used as an adjunct to surgical treatment in the postoperative period in selected cases where no bony impingement is present. 

scholarly journals A prospective comparison of short-term results after arthroscopic and open elbow procedures in elbow stiffness

2019 ◽  
Vol 14 (4) ◽  
pp. 263-268 ◽  
Author(s):  
T. Leschinger ◽  
M. Hackl ◽  
M. Lenz ◽  
V. Rausch ◽  
L. P. Müller ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Dash Score ◽  
Open Approach ◽  
Elbow Stiffness ◽  
Short Term ◽  
Open Arthrolysis ◽  
Stiff Elbow ◽  
Prospective Comparison ◽  
Elbow Movement

Abstract Background Surgical treatment of the stiff elbow can be performed either arthroscopically or via an open approach. There is a paucity of direct prospective comparisons of the techniques in the literature. Objectives The aim of the study is to analyze the clinical short-term results of arthroscopic and open elbow arthrolysis in postoperative and posttraumatic stiff elbows. Materials and methods The study group consisted of 44 patients divided in two cohorts, one after arthroscopic arthrolysis (33 patients) and the other including patients after open arthrolysis (11 patients). Range of motion (ROM; extension/flexion), pain (numerical rating scale, NRS), as well as the disabilities of the arm, shoulder, and hand (DASH) score were recorded preoperatively and examined in a standardized manner 6 weeks, 3 months, and 6 months after surgery. Results In both groups, preoperative elbow movement significantly improved in the follow-up. An increase from 103.3° (±23.4) to 123.5° (±12.5°; p = 0.001) was seen after 6 months for the arthroscopic group, whereas the mean ROM significantly increased from 64.5° (±31.1°) to 100.9° (±25.6°; p = 0.007) following open arthrolysis. In the arthroscopic group, the DASH score was measured at 37.3 points (±23.4 points) and improved to 16.1 points (±16.5 points) after 6 months, while in the open group it enhanced after 6 months (19.5 points [±17.5 points]) compared to its preoperative value by 38.2 points (±24.1 points). A consistent improvement was found for NRS, which decreased after surgery in both groups (arthroscopic group = −3.1 [±3.0]; open group = −2.0 [±2.9]). Complications did not occur in either group. When comparing delta values of the groups between the preoperative ROM, DASH score, and NRS, no significant differences were observed (p < 0.05). Conclusions Good to excellent functional recovery was seen in both cohorts when evaluating for improvement in the DASH score, the gain in elbow motion, and the decrease in pain. No significant differences were found between the procedures regarding pre- and postoperative measurements. The arthroscopic approach has developed to become an effective alternative to treat posttraumatic elbow stiffness.

scholarly journals Arthroscopic Treatment of Stiff Elbow

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Davide Blonna ◽  
Enrico Bellato ◽  
Eleonora Marini ◽  
Michele Scelsi ◽  
Filippo Castoldi
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Range Of Motion ◽  
Arthroscopic Management ◽  
Acceptable Range ◽  
Stiff Elbow ◽  
Tissue Trauma ◽  
Elbow Contracture

Contracture of the elbow represents a disabling condition that can impair a person's quality of life. Regardless of the event that causes an elbow contracture, the conservative or surgical treatment is usually considered technically difficult and associated with complications. When the conservative treatment fails to restore an acceptable range of motion in the elbow, open techniques have been shown to be successful options. More recently the use of arthroscopy has become more popular for several reasons. These reasons include better visualization of intra-articular structures, less tissue trauma from open incisions, and potentially the ability to begin early postoperative motion. The purpose of this paper is to review the indications, complications, and results of arthroscopic management of a stiff elbow.

scholarly journals The effect of tissue elastic properties and surfactant on alveolar stability

2010 ◽  
Vol 109 (5) ◽  
pp. 1369-1377 ◽  
Author(s):  
Steen Andreassen ◽  
Kristoffer L. Steimle ◽  
Mads L. Mogensen ◽  
Jorge Bernardino de la Serna ◽  
Stephen Rees ◽  
...  
Keyword(s):  
Elastic Properties ◽  
Pulmonary Surfactant ◽  
Hysteretic Behavior ◽  
Spherical Approximation ◽  
Infinite Volume ◽  
Comprehensive Model ◽  
Tissue Elasticity ◽  
Tidal Breathing ◽  
Alveolar Stability ◽  
The Stability

This paper presents a novel mathematical model of alveoli, which simulates the effects of tissue elasticity and surfactant on the stability of human alveoli. The model incorporates a spherical approximation to the alveolar geometry, the hysteretic behavior of pulmonary surfactant and tissue elasticity. The model shows that the alveolus without surfactant and the elastic properties of the lung tissue are always at an unstable equilibrium, with the capability both to collapse irreversibly and to open with infinite volume when the alveolus has small opening radii. During normal tidal breathing, the alveolus can becomes stable, if surfactant is added. Including the passive effect of tissue elasticity stabilizes the alveolus, further allowing the alveoli to be stable, even for lung volumes below residual volume. The model is the first to describe the combined effects of tissue elasticity and surfactant on alveolar stability. The model may be used as an integrated part of a more comprehensive model of the respiratory system, since it can predict opening pressures of alveoli.

scholarly journals PO 18122 - Treatment of Charcot arthropathy in the ankle joint

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 21S
Author(s):  
Milena Peloggia Cursino Fernandes ◽  
Noé De Marchi Neto ◽  
Ricardo Cardenuto Ferreira ◽  
Marco Tulio Costa ◽  
Jordanna Bergamasco ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Ankle Joint ◽  
Reconstructive Surgery ◽  
Joint Destruction ◽  
Charcot Arthropathy ◽  
Clinical Evaluations ◽  
Good Outcome ◽  
The Mean ◽  
The Stability ◽  
Acceptable Outcome

Introduction: Charcot arthropathy can lead to joint destruction and often causes ulcers at sites of bony prominences. In the ankle, it causes instability that limits gait and makes it difficult for patients to wear shoes or orthoses. This was a retrospective study describing cases of Charcot arthropathy of the ankle treated at our institution from 1997 to 2017. Methods: Over the study period, we treated 252 patients with Charcot arthropathy. Of these patients, 27 presented the disease exclusively in the ankle. The selected cases were unilateral; 17 of the patients were men, and the mean age was 55 years. Nine patients were treated conservatively, and 18 were treated surgically to stabilize the ankle (including the hindfoot, if necessary). During surgery, different fixation methods were used depending on the presence or absence of ulcer at the time of the intervention. At the end of the treatment, we assessed the patient’s ability to wear shoes or orthoses for walking, the stability of the ankle joint and, in surgical cases, union. We considered a good outcome when the patient was able to walk wearing shoes or orthoses, and the limb was stable; an acceptable outcome when the limb was unstable, but the patient adapted to orthoses; and a poor outcome when the patient was unable to walk, and the ankle was unstable or amputated. Results: Nine patients underwent conservative treatment using total contact casting at the initial phase of the disease, followed by orthosis after union. Of these patients, the outcome was poor for 5, good for 3 and acceptable for 1. Eighteen patients underwent reconstructive surgery; 12 patients had a good outcome; 2 patients underwent amputation, and 4 patients had unsuccessful surgeries. Conclusion: Charcot arthropathy of the ankle causes considerable instability. Conservative treatment of the disease fails to provide good outcomes, and the patients who underwent reconstructive surgery had the best functional and clinical evaluations.  

scholarly journals Open elbow arthrolysis for post-traumatic elbow stiffness

2020 ◽  
Vol 1 (9) ◽  
pp. 576-584 ◽  
Author(s):  
Ziyang Sun ◽  
Weixuan Liu ◽  
Juehong Li ◽  
Cunyi Fan
Keyword(s):  
Upper Limb ◽  
Conservative Therapy ◽  
Preoperative Evaluation ◽  
Diagnosis And Treatment ◽  
Elbow Stiffness ◽  
Postoperative Rehabilitation ◽  
Stiff Elbow ◽  
Post Traumatic ◽  
Elbow Arthrolysis

Post-traumatic elbow stiffness is a disabling condition that remains challenging for upper limb surgeons. Open elbow arthrolysis is commonly used for the treatment of stiff elbow when conservative therapy has failed. Multiple questions commonly arise from surgeons who deal with this disease. These include whether the patient has post-traumatic stiff elbow, how to evaluate the problem, when surgery is appropriate, how to perform an excellent arthrolysis, what the optimal postoperative rehabilitation is, and how to prevent or reduce the incidence of complications. Following these questions, this review provides an update and overview of post-traumatic elbow stiffness with respect to the diagnosis, preoperative evaluation, arthrolysis strategies, postoperative rehabilitation, and prevention of complications, aiming to provide a complete diagnosis and treatment path. Cite this article: Bone Joint Open 2020;1-9:576–584.

Release of the stiff elbow followed by continuous passive motion and indomethacin treatment

1995 ◽  
Vol 4 ◽  
pp. S20 ◽  
Author(s):  
J.O. Søjbjerg ◽  
P. Kj˦rsgaard-Andersen ◽  
H.V. Johanssen ◽  
O. Sneppen
Keyword(s):  
Continuous Passive Motion ◽  
Passive Motion ◽  
Stiff Elbow ◽  
Indomethacin Treatment

In Vitro Evaluation of Evacuated Blood Collection Tubes as a Closed-Suction Surgical Drain Reservoir

2018 ◽  
Vol 54 (1) ◽  
pp. 30-35
Author(s):  
Brian Heiser ◽  
E.B. Okrasinski ◽  
Rebecca Murray ◽  
Kelly McCord
Keyword(s):  
Blood Collection ◽  
Expiration Date ◽  
Closed Suction ◽  
Volume Curve ◽  
Negative Pressures ◽  
The Stability ◽  
Surgical Drain ◽  
In Vitro Performance ◽  
Blood Collection Tubes

ABSTRACT The initial negative pressures of evacuated blood collection tubes (EBCT) and their in vitro performance as a rigid closed-suction surgical drain (CSSD) reservoir has not been evaluated in the scientific literature despite being described in both human and veterinary texts and journals. The initial negative pressures of EBCT sized 3, 6, 10, and 15 mL were measured and the stability of the system monitored. The pressure-to-volume curve as either air or water was added and maximal filling volumes were measured. Evacuated blood collection tubes beyond the manufacture’s expiration date were evaluated for initial negative pressures and maximal filling volumes. Initial negative pressure ranged from −214 mm Hg to −528 mm Hg for EBCT within the manufacturer’s expiration date. Different pressure-to-volume curves were found for air versus water. Optimal negative pressures of CSSD are debated in the literature. Drain purpose and type of exudates are factors that should be considered when deciding which EBCT size to implement. Evacuated blood collection tubes have a range of negative pressures and pressure-to-volume curves similar to previously evaluated CSSD rigid reservoirs. Proper drain management and using EBCT within labeled expiration date are important to ensure that expected negative pressures are generated.

scholarly journals Total elbow arthroplasty surgery in neglected elbow stiffness post open reduction and internal fixation with plate and screw: a case report

2020 ◽  
Vol 8 (12) ◽  
pp. 4525
Author(s):  
I. Gede Mahardika Putra ◽  
Made Bramantya Karna
Keyword(s):  
Internal Fixation ◽  
Total Elbow Arthroplasty ◽  
Dash Score ◽  
Heterotopic Bone ◽  
Heterotopic Bone Formation ◽  
Elbow Stiffness ◽  
Postoperative Rehabilitation ◽  
Elbow Arthroplasty ◽  
Total Elbow Replacement ◽  
Stiff Elbow

Post-traumatic and post-operative stiffness of the elbow joint constitutes a significant problem since the elbow is prone to develop soft-tissue contractures and heterotopic bone formation especially if happened in dominant arm. Total elbow replacement is considered as an ultimate treatment in salvaging a stiff elbow which has failed conservative and operative therapeutic procedures to overcome the stiffness and return the elbow to an effective functional arc. A 35-year-old female came to orthopaedic outpatient clinic in Sanglah Hospital, complaining on stiffness in her right elbow since one year prior to admission. This complain was felt after she underwent internal fixation on July 19th 2016, for closed fracture right monteggia bado type-3 post internal fixation. After the surgery, she couldn’t move her elbow because of inappropriate physiotheraphy. Neglected elbow stiffness in this patient was treated surgically with total elbow arthroplasty after physiotherapy has failed to improve her range of motion over 1-year period postoperatively. This decision stated when nonsurgical treatment fails, the patient who has realistic expectations of eventual outcome and who can comply with the arduous postoperative rehabilitation program may be a surgical candidate. Total elbow arthroplasty conducted for these patients resulted in satisfying functional outcome with using quick disabilities of the arm, shoulder and hand (DASH) score improved from 81.8 to 43.2 postoperatively and no complication was reported.

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