Loss of Elbow Motion

Acute and chronic disorders of the elbow are frequently observed in both recreational and professional athletes, particularly athletes who participate in sports that involve throwing. Although clinicians most frequently evaluate athletes in throwing-related sports who have elbow pathology related to overuse injuries, including ulnar collateral ligament insuffi ciency, valgus extension overload syndrome, and epicondylitis, acute elbow trauma may affect athletes in all sports. These acute injuries most commonly include elbow fractures/ dislocations after falls onto an outstretched hand. The injuries may occur in sports such as wrestling, as a result of the combination of compression and torque applied to the arm when competitors are driven into the mat, or weight lifting, as a result of spontaneous dislocation from massive exertion, as was witnessed at the 2012 Summer Olympic Games. Elbow osteoarthritis is almost uniquely seen in middle-aged muscular men who may have been involved in repetitive, strenuous athletic endeavors, especially boxing and weightlifting. Loss of mobility is the most common complication after elbow injury. The predisposition of the elbow to the development of posttraumatic contracture has been attributed to several factors, including the intrinsic congruity of the ulnohumeral articulation, the presence of three articulations within a synovium-lined cavity, and the intimate relationship of the joints to the intracapsular ligaments and extracapsular muscles. 1-3 Several authors have studied the degree of elbow motion necessary to complete daily activities. Their conclusions have yielded a functional arc of 100 degrees (range, 30 to 130 degrees) of fl exion and extension of the elbow and 100 degrees of rotation of the forearm (50 degrees each for pronation and supination). 4 The inability of the elbow to achieve this degree of fl exibility after trauma may lead to substantial impairment of upper extremity function. For patients whose elbow contracture is refractory to conservative management, surgical debridement and release of the elbow is offered to restore functional motion of the joint. Although open approaches have classically been described for the surgical treatment of the posttraumatic elbow contracture, arthroscopic techniques have recently emerged as a less invasive alternative with similar effi cacy for the treatment of elbow stiffness. Although several authors have attempted to formulate classifi cation schemes to grade the severity of elbow stiffness, the system devised by Morrey 5 most accurately accounts for both osseous and soft tissue pathology contributing to loss of motion. Morrey divides the etiologies of elbow stiffness into either intrinsic or extrinsic factors. Intrinsic factors include intraarticular adhesions and loose bodies, articular malalignment, and loss of articular cartilage, whereas extrinsic factors include capsular and ligamentous contracture, heterotopic ossifi cation (HO), extraarticular malunion, ulnar neuropathy, and postburn contracture of the superfi cial soft tissues. All of these potential sources of motion loss should be considered and separately addressed in patients who present with a stiff elbow.