What is stiff elbow?Elbows can become stiff due to a problem either inside the joint (intra-articular) or in the tissues around the elbow but outside the joint (extra-articular).
The most common cause of stiffness arising from the inside of the joint is due to arthritis. This can be related to wear and tear (osteoarthritis) or from a previous injury or infection. Other types of inflammatory arthritis can lead to elbow pain and stiffness such as rheumatoid arthritis. Elbow stiffness may follow injury, fracture or even dislocation of the elbow, where the capsule (lining) of the joint shrinks and reduces movement.
Elbow stiffness can also be due to problems that lie outside the joint. These include tightness of the skin and muscles, such as after burns, or bone formation in the tissues occurring after an injury or surgery (heterotropic ossification).
Less commonly we see abnormalities that people are born with (congenital) that lead to elbow stiffness.
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What are the symptoms and signs?The main symptoms are a loss of movement in the elbow. Normally, the elbow can straighten fully (extend) and bend (flex) sufficiently to allow us to perform the movements we need. The elbow is also involved in movements required to rotate the forearm and hand (pronate and supinate). Loss of any of these movements can be a sign of a problem within the elbow (or wrist). Some patients can experience pain and grating with elbow movements, while others may have the sensation of the elbow locking or jamming. These are characteristic of different problems in the elbow and can assist in making the diagnosis.
How is stiff elbow diagnosed?An X-ray is an invaluable test in the diagnosis of elbow stiffness. This is often all that is needed, however in more complicated cases, a CT or an MRI scan may offer further information. Sometimes it is necessary to supplement this test with an injection to outline the joint structures more clearly (arthrogram).
How is it treated?
For most patients, the loss of some elbow movement has little impact on day-to-day activities. When the loss of movement reaches certain measured levels or begins to impact significantly on normal function, then further options are considered.
- Pain control – initially treatment is centred around improving the painful symptoms. This involves rest, avoiding painful activities, and the use of painkillers such as paracetamol and anti-inflammatory medications. A doctor or pharmacist should be able to advise which ones are safe to take.
- Physiotherapy – this has an important role in the management of a stiff elbow. It is important that the elbow is not forcibly straightened or bent, particularly if this is painful.
- Injections – steroid injections can provide some pain improvement. The pain relieving effects of the steroids tend to work within a couple of weeks and may last for many months. Side effects of steroids are uncommon, but can include them not having any pain relieving benefit, damage to the underlying tendons and ligaments (especially if too many are administered), infection and post-injection flare of symptoms (lasting two to three days - 5%).
Where the previous treatments have failed to improve symptoms sufficiently, then surgery is considered. This can be performed using keyhole or open techniques, or a combination of the two.
- Arthroscopic / keyhole debridement – this operation requires general anaesthesia and utilises several small incisions around the elbow to insert a camera and instruments. It is possible to remove loose bodies and spurs of bone in this way as well as assessing the degree of wear and tear in the joint.
- Outerbridge-Kashiwagi (OK) procedure – commonly performed in stiff, arthritic elbows. This procedure involves making an incision over the back of the elbow and removing any bony spurs that block straightening (extension) of the arm. It is also possible to make a small window into the front of the elbow to remove any spurs on this side to improve elbow movement. This procedure does not restore the elbow to normal, but can lead to gains in pain relief and movement.
- Elbow arthrolysis – this is used for severely stiff elbows, particularly after trauma and fractures. It may be possible to remove any previous metal plates and screws and free up any tight scar tissue. Intensive physiotherapy is essential after this procedure. Occasionally it is necessary to remain in hospital for this to take place to get the benefit of a continuous nerve block to provide pain relief.
What are the potential complications?The complications of surgery include infection, bleeding and nerve injury. Perversely, there is a risk of stiffening back up after surgery though many patients see movements return over a six-month rehabilitation period. If arthritis is present, and an OK procedure has been preformed, pain and stiffness will likely re-occur at some point in the future as the disease process progresses, the benefits however can last many many years.
A big thank you to Simon and his team for their care, patience and perseverence looking after me through all stages of both shoulder and elbow surgery.
Since the shoulder stabilisation I have continued my sailing and fitness training without the worry that my shoulder might dislocate; and I don’t have to think twice whether my ulnar nerve will hinder any progression in my sports.
With their amazing help, I’ve been able to get back to sailing competatively and am now a double National champion.
After multiple shoulder dislocations Charlie helped me set a route for recovery, which has been nothing but smooth sailing. Surgery went successfully and I am well on my way to playing the sports I was previously. Would highly recommend.
Simon successfully operated on my frozen left shoulder in 2012 with fantastic results. This year he has overseen and advised treatment for my frozen right shoulder (via hydrodilation injection). His unrivalled experience in orthopaedic shoulder treatments, coupled with his reassuring bedside manner and excellent results, gave me huge confidence throughout. I’m hugely grateful to have my quality of life back and wouldn’t hesitate to recommend his services. Thank you Simon.
I had suffered with a painful shoulder and pins and needles for three years following a right shoulder fracture and failed half joint replacement prior to meeting Mr Pennington. He explained the situation in a way I could relate to and I’m delighted to say my revision shoulder replacement has gone well and for the first time in years I can use my arm and am pain free. I was even able to walk my daughter down the aisle 3 months after surgery! Many thanks.
I would like to thank Charlie Talbot and his team for the operations performed on both my shoulders and also the aftercare put in place after my operations. I have played golf since I was 12 years of age and thought at one point that I would never get back to playing again. Charlie was always very positive and told me that he would get me playing golf again. Well, I have now been playing golf for nearly 2 years. Before surgery I had a handicap of 12 and I am now down to 9, not bad at the age of 68. So many many thanks.
I had PRP injections into my right elbow last year and within 3 months I was pain free, a year on it is more or less 100% better. Fabulous I would recommend it to anyone with Tennis Elbow, in fact I have gone back again this year to get my left elbow done. Thanks Simon.
Mr Pennington I really wanted you to know how very thankful I am for the excellent care & treatment you and your staff gave me. It really meant a lot that you were so clear, friendly & professional and listened to me – so thank you again.
After more than four decades of shoulder problems with a total of three surgeries the full shoulder replacement surgery by Mr. Talbot has changed my life beyond expectations. I am now able bodied for the first time in years and pain free.
Thank you to Mr Boyle and team for the excellent care and attention both before and after Replacement Shoulder surgery, using the Tornier Simpliciti procedure. After very many months of severe pain and lack of movement I was pain free from day one. Now, after nine weeks, the shoulder and arm movement continues to improve, beyond expectation, with physiotherapy and exercise. I am extremely grateful for all the continuing care.
Following two years of recurrent problems with my left shoulder I was recommendedto Consult Mr Neil Pennington. I had the opportunity to have my surgery quickly and at my convenience, this fitted well around my professional and home commitments. The surgery was carried out as a day case procedure and Mr Pennington visited me following the surgery to explain everything. My operation was a minimally invasive procedure so my recovery was straightforward with only a few restrictions; in fact I was encouraged to keep my shoulder moving. I was driving and back to work after 2 weeks – after 2 years of pain and sleep disturbance I found this operation to be life changing! I found Mr Pennington to be a very professional and compassionate surgeon and he is surrounded by a whole team of professionals that gave me the utmost confidence in the care and treatment I received.
I would like to thank Mr. Talbot and the amazing team of nurses, physiotherapists and support staff for their care and support during my recent visit to the Duchy Hospital, Harrogate, for a replacement shoulder. The care and attention I received was unparalleled. The pain free movement I now have has changed my life.