Living with a stiff, inflexible elbow can make everyday activities challenging and frustrating. Simple tasks like getting dressed, carrying groceries, or even bringing a cup of coffee to your lips can become difficult. If you’re experiencing a limited range of motion in your elbow, you may have a condition known as elbow contracture.
At California Pacific Orthopaedics, our team of board-certified orthopedic specialists in San Francisco is dedicated to helping you understand your condition and find the most effective treatment to restore movement and improve your quality of life. We combine compassionate care with leading-edge diagnostics and a wide range of treatment options, from physical therapy to minimally invasive surgery.
What is Elbow Contracture?
Elbow contracture, often simply called a “stiff elbow,” is a condition where the soft tissues surrounding the elbow joint—including the joint capsule, ligaments, and tendons—become tight, shortened, and scarred. This tightening, a process known as fibrosis, restricts the elbow’s ability to fully bend (flexion) or straighten (extension).
The normal, functional range of motion for an elbow is from about 30 to 145 degrees. When this range is diminished by 30 degrees or more, it is typically diagnosed as a contracture. A significant loss of motion, particularly a flexion contracture of more than 45 degrees, can severely impact your ability to perform daily self-care activities like eating and bathing.
While some stiffness is common after an injury or surgery, persistent and worsening stiffness is a sign that you should seek a medical evaluation from an orthopedic specialist.
Common Symptoms and Causes of Elbow Contracture
Recognizing the signs of elbow contracture is the first step toward getting the right diagnosis and treatment.
Symptoms
The primary symptom of elbow contracture is a noticeable stiffness and the inability to fully extend or flex the arm. You might find that you can’t straighten your arm completely or bend it as far as you used to. Other symptoms may include:
- A feeling of tightness or pulling in the elbow when you try to move it.
- Swelling around the elbow joint.
- Muscle weakness in the affected arm.
- In some cases, numbness or tingling in the hand and fingers, particularly the ring and small fingers, which could indicate that the ulnar nerve is affected.
- Unlike many other joint conditions, elbow contracture is often not painful during rest or gentle movement, but pain can occur when the elbow is stretched to its limit.
Causes
Elbow contracture is most commonly the result of trauma or inflammation. The body’s natural response to injury is to form scar tissue, but sometimes it produces too much, leading to the tightening of the soft tissues. The leading causes include:
- Trauma: Fractures, dislocations, and severe sprains of the elbow are the most frequent culprits. The injury itself, as well as the necessary period of immobilization in a cast or splint, can contribute to stiffness.
- Surgery: Any surgical procedure on the elbow, including fracture repair or ligament reconstruction, can lead to the formation of scar tissue and subsequent contracture.
- Prolonged Immobilization: Keeping the elbow in one position for an extended period, whether in a cast or due to inactivity from another illness, can cause the soft tissues to tighten.
- Arthritis: Both osteoarthritis (wear-and-tear arthritis) and rheumatoid arthritis (an autoimmune disease) can cause inflammation, pain, and damage to the joint, leading to stiffness.
- Heterotopic Ossification: This is a condition where bone tissue forms in places where it doesn’t belong, such as in muscles or soft tissues around the elbow. This abnormal bone growth can physically block the joint’s movement.
- Burns: Severe burns can cause extensive scarring of the skin and underlying tissues, leading to contractures.
- Neurological Conditions: Conditions like cerebral palsy, stroke, or traumatic brain injury can cause muscle spasticity, where muscles remain continuously contracted, leading to joint stiffness.
Common Risk Factors for Elbow Contracture
While anyone can develop a stiff elbow after an injury, certain factors can increase your risk:
- Severity of the Initial Injury: Complex fractures, particularly those involving the joint surface (intra-articular fractures) or dislocations, have a higher risk of leading to contracture.
- Multiple Surgeries: Each surgical procedure carries a risk of scar tissue formation. Patients who require multiple operations on the same elbow are at a higher risk.
- Delayed Treatment or Rehabilitation: The longer the elbow remains immobile and stiff, the more difficult it is to regain motion. Early and appropriate physical therapy is crucial.
- Associated Injuries: Head injuries or severe burns sustained at the same time as an elbow injury can increase the likelihood of developing heterotopic ossification and subsequent stiffness.
- Genetic Predisposition: Some individuals may be more prone to forming excessive scar tissue.
- Non-compliance with Physical Therapy: Adherence to a prescribed rehabilitation program is one of the most critical factors in preventing and treating elbow contracture.
Diagnosis and Treatment at California Pacific Orthopaedics
If you’re experiencing elbow stiffness, our specialists in San Francisco will conduct a thorough evaluation to determine the cause and severity of your condition.
Diagnosis
Your visit will begin with a comprehensive medical history and a physical examination. Your doctor will ask about your symptoms, any previous injuries or surgeries, and how the stiffness is affecting your daily life. During the physical exam, your doctor will carefully assess your elbow’s range of motion, both actively (you moving your arm) and passively (the doctor moving your arm).
To get a clearer picture of the inside of your elbow, your doctor may order imaging studies, such as:
- X-rays: To identify any bone abnormalities, fractures, or signs of arthritis.
- CT Scan: To get a more detailed look at the bones and any potential bony blocks to motion.
- MRI: To visualize the soft tissues, such as the joint capsule, ligaments, and tendons.
Treatment Options
Our goal is to provide the least invasive, most effective treatment to restore your elbow’s function. Treatment plans are tailored to your specific condition, the underlying cause, the severity of the contracture, and your personal goals.
Nonsurgical Treatments
For many patients, especially those with less severe contractures of shorter duration, conservative treatments are highly effective. These may include:
- Physical and Occupational Therapy: This is the cornerstone of treatment. A skilled therapist will guide you through specific stretching and strengthening exercises to gradually improve your range of motion.
- Splinting: Custom-made static or dynamic splints can be used to apply a gentle, prolonged stretch to the soft tissues, helping them to lengthen over time.
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. In some cases, injections of corticosteroids or other medications may be recommended.
Surgical Treatment: Elbow Capsular Release
If nonsurgical treatments fail to provide significant improvement, or if the contracture is severe, surgery may be recommended. The most common procedure is an elbow capsular release, where the surgeon removes the tightened, scarred joint capsule and other restrictive tissues.
This procedure can often be performed arthroscopically, a minimally invasive technique that uses small incisions and a tiny camera to view and work inside the joint. Arthroscopic surgery typically results in less pain, a quicker recovery, and less scarring than traditional open surgery.
Following surgery, a dedicated physical therapy regimen is crucial to maintain the motion gained during the procedure and to ensure the best possible outcome.
Take the Next Step with California Pacific Orthopaedics
Don’t let a stiff elbow limit your life. The experienced and compassionate team at California Pacific Orthopaedics is here to help you regain your mobility and get back to the activities you love. With convenient locations in the San Francisco Bay Area, we offer a patient-centered approach to orthopedic care.
Contact us today to schedule a consultation and learn more about your treatment options for elbow contracture.
