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The Stiff Elbow
Selected Features of Our Program
- Careful analysis of the true reasons for stiffness
- Step by step protocol for release and testing
of motion
- Aggressive rehabilitation designed to maximize
final result
Evaluation and Diagnosis
After injury or previous
surgery, the elbow can become very stiff with scar tissue. The loss
of function that results can be disabling. After a while, any further
therapy may prove useless. Patients may experience pain, stiffness,
weakness, and the inability to perform certain tasks. Diagnosing
the true cause of stiffness requires an expert elbow surgeon with
considerable experience in the field of revision surgery for scarring
and lost motion. There are many reasons for stiffness that involve
the joint itself, tendons, and unwanted bone formation. Major nerves
that pass through the region must be considered. Careful analysis
of each of these structures and how they might affect each other
is the key to proper planning and treatment.
Treatment and Recovery
When the elbow surgeon
first sees the patient, an evaluation of the cause of stiffness
directs the initial treatment. If there is any suggestion that further
non-surgical therapy will be of benefit, a comprehensive program
of manual motion exercises and proper splinting is carried out.
This may be all some patients require. If the scar tissue is mature
and cannot be softened by therapy, then only surgery can improve
the situation. Releasing scar tissue must be done in a specific
sequence of steps followed by testing of motion to determine the
contribution of each of the tissues to the stiffness. Careful protection
of the major nerves must be a part of each step of the operation.
Sometimes the nerves must even be moved to a new location. There
must always be a back-up plan to keep the elbow stable after release
that includes reconstructing the main ligaments and providing outside
support to the joint. The patient goes immediately from surgery
into a daily therapy program with specific exercises and splints
designed to maximize the functional recovery. Even though solving
the stiff elbow can be very challenging, with a good plan and a
motivated patient, major improvement in pain and function can be
achieved.
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