ELBOW ARTHROLYSIS FOR POST-TRAUMATIC STIFFNESS: A SINGLE SURGEON, SINGLE OBSERVER (PHYSIOTHERAPIST) STUDY

Abstract

Over the last 15 years there have been a series of publications reporting the beneficial effects of elbow arthrolysis, with considerable variation in operative technique and post-operative management.

Aim. To assess the results of open elbow arthrolysis in patients who did not receive any physiotherapy after discharge from hospital, although this is routinely prescribed by many surgeons.

Patients and Methods. Prospectively collected data of 34 patients with a minimum follow-up of 1 year after arthrolysis was analysed. All the procedures were performed by the same surgeon, achieving as much improvement in elbow motion as possible at operation. All the patients had continuous brachial plexus blocks and continual passive motion for 2–3 days postoperatively but none received any physiotherapy after discharge. At review, a senior physiotherapist formally assessed all the patients, including measuring elbow motion with a goniometer.

Results. All patients’ arc of movement improved from, with mean elbow flexion increasing by 16 degrees and extension 20 degress at the last follow-up. Upper limb function, assessed with a Disabilities of the Arm, Shoulder and Hand score (DASH), had improved 30%. Pain had decreased from 4.8 to 3.1 using the Visual Analogue Score. The greatest improvement in motion was obtained in the stiffest elbows – 5 patients with an arc of 30 degrees or less pre-operatively achieved an arc of 96 degrees by the time of the last review. Only early complications occurred – ulnar neuritis and significant pain – but these symptoms had largely settled by the time of the last review.

Conclusions. Good results of open arthrolysis for post-traumatic elbow stiffness can be achieved with continuous brachial plexus blocks and continual passive motion for 2–3 days post-operatively. There appears to be little evidence to support formal treatment with physiotherapy after discharge from hospital, as our results are similar to other reported series.