scholarly journals Arthroscopic Adhesiolysis in a Stiff Elbow

2021 ◽  
pp. 343-347
Author(s):  
L. A. Pederzini ◽  
F. Serafini ◽  
F. Nicoletta ◽  
A. Celli
Keyword(s):  
2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 913.2-914
Author(s):  
T. Birinci ◽  
E. Kaya Mutlu ◽  
S. Altun

Background:Elbow fracture is treated either conservatively or surgically followed by a period of immobilization with casting or splinting. A splint used to immobilize upper limbs for many weeks results in changes in both the peripheral musculature and the central nervous system. It is well known that common complaints after upper limb fractures include weakness, pain, and stiffness; therefore, pain management is important in the early stages of the rehabilitation of upper limb fractures.Objectives:This pilot study aimed to investigate the efficacy of graded motor imaginary (GMI) on pain, range of motion (ROM), and function in patients with posttraumatic stiff elbow.Methods:Fourteen patients with posttraumatic stiff elbow (6 women, mean age: 45.42 ± 11.26 years, mean body mass index: 24.29 ± 3.38 kg\m2and mean duration of immobilization: 4.75 ± 1.03 weeks) were randomly allocated to either GMI or control groups. The GMI group received GMI treatment in addition to a structured exercise program, and the control group received a structured exercise program (two days per week for six weeks) (Figure 1). The assessments included pain at rest and during activity using the visual analog scale (VAS), elbow active ROM with a digital goniometer (Baseline Evaluation Instrument, Fabrication Enterprises, Inc., White Plains, NY), and upper extremity functional status using the Disability of the Arm, Shoulder and Hand Questionnaire (DASH). The assessments were performed at baseline and after the 6-week intervention.Figure 1.Graded motor imagery performed with mirror boxResults:After the 6-week intervention, there was a significant increase in elbow flexion-extension ROM and supination-pronation ROM, and improvement in DASH score in both groups (p<0.05). However, improvement in VAS-rest and VAS-activity was significantly higher in the GMI group than the control group (p=0.03 and p=0.01, respectively).Conclusion:A conservative treatment program consisting of GMI treatment in addition to a structured exercise program applied twice a week for 6 weeks, has been found more effective in decreasing pain in the posttraumatic stiff elbow. It could be concluded that GMI is an effective treatment method for elbow fracture in patients with predominant elbow pain.References:[1] Harris JE, Hebert A. Utilization of motor imagery in upper limb rehabilitation: a systematic scoping review. Clin Rehab. 2015:29(11):1092-1107.[2] Opie GM, Evans A, Ridding MC, Semmler JG. Short-term immobilization influences use-dependent cortical plasticity and fine motor performance. Neuroscience. 2016:330:247-256.[3] Birinci T, Razak Ozdincler A, Altun S, Kural C. A structured exercise programme combined with proprioceptive neuromuscular facilitation stretching or static stretching in posttraumatic stiffness of the elbow: a randomized controlled trial. Clin Rehab. 2019:33(2):241-252.Acknowledgments:The present work was supported by the Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa (Project No: TDK-2019-33997).Disclosure of Interests:None declared


2010 ◽  
Vol 23 (4) ◽  
pp. e14-e15
Author(s):  
Maria A. Davalos ◽  
Gerardo Gallucci ◽  
Veronica Alfie ◽  
Pablo de Carli ◽  
Maria G. Thomas
Keyword(s):  

Author(s):  
Venkata Sivaram G. V. ◽  
Y. V. S. Prabhakar

<p class="abstract"><strong>Background:</strong> Inter-condylar fractures represent one of the most complicated and challenging fractures in the upper extremity. The results of managing these fractures non-operatively are limited by failure to get anatomical reduction and early mobilization, which often results in painful stiff elbow and/or pseudo-arthrosis. The objective of this study was to evaluate and analyse the role of open reduction and internal fixation in inter-condylar fractures of distal humerus.</p><p class="abstract"><strong>Methods:</strong><strong> </strong>The present study was done in Malla Reddy Institute of Medical Sciences between June 2014 and June 2017. Out of 34 cases of intercondylar fractures of humerus admitted during the period, 25 patients were selected for the study that satisfied our inclusion criteria. Three patients out of those selected could not be included in the study as one had cardiac issues pre-operatively, one refused surgery and one was lost to follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our study included 22 patients, 14 male and 8 female patients. Their average age was 41.4 years. The fractures were classified as per the AO classification. There were B1-3, B2-1, C1-6, C2-5, C3-7 fractures. Both compound and closed fractures were included. All the patients were operated by posterior olecranon Chevron osteotomy approach by a senior faculty member. Twenty two patients who satisfied our inclusion criteria were treated, followed up and the results analyzed using Cassabaum’s scale of elbow function we had 86% of excellent to good results. Our results are comparable with other similar studies.</p><p class="abstract"><strong>Conclusions:</strong> Posterior olecranon approach was found to be of most satisfactory approach by us. It allows good exposure of the joint and the ulnar nerve.</p>


2018 ◽  
Vol 6 (5) ◽  
pp. 2886-2890
Author(s):  
Thiruvarangan Suwaminathan ◽  
◽  
Niroshan Jayarathne ◽  
Sukunan Gunasingam ◽  
◽  
...  

2009 ◽  
Vol 44 (4) ◽  
pp. 336-341
Author(s):  
Alberto Naoki Miyazaki ◽  
Marcelo Fregoneze ◽  
Pedro Doneux Santos ◽  
Luciana Andrade da Silva ◽  
Nelson Gennaro Junior ◽  
...  

2005 ◽  
Vol 40 (6) ◽  
pp. 723 ◽  
Author(s):  
Chung Soo Han ◽  
Yong Girl Rhee ◽  
Bi O Jeong ◽  
Boo Kyung Kwon
Keyword(s):  

2019 ◽  
Vol 14 (4) ◽  
pp. 263-268 ◽  
Author(s):  
T. Leschinger ◽  
M. Hackl ◽  
M. Lenz ◽  
V. Rausch ◽  
L. P. Müller ◽  
...  

Abstract Background Surgical treatment of the stiff elbow can be performed either arthroscopically or via an open approach. There is a paucity of direct prospective comparisons of the techniques in the literature. Objectives The aim of the study is to analyze the clinical short-term results of arthroscopic and open elbow arthrolysis in postoperative and posttraumatic stiff elbows. Materials and methods The study group consisted of 44 patients divided in two cohorts, one after arthroscopic arthrolysis (33 patients) and the other including patients after open arthrolysis (11 patients). Range of motion (ROM; extension/flexion), pain (numerical rating scale, NRS), as well as the disabilities of the arm, shoulder, and hand (DASH) score were recorded preoperatively and examined in a standardized manner 6 weeks, 3 months, and 6 months after surgery. Results In both groups, preoperative elbow movement significantly improved in the follow-up. An increase from 103.3° (±23.4) to 123.5° (±12.5°; p = 0.001) was seen after 6 months for the arthroscopic group, whereas the mean ROM significantly increased from 64.5° (±31.1°) to 100.9° (±25.6°; p = 0.007) following open arthrolysis. In the arthroscopic group, the DASH score was measured at 37.3 points (±23.4 points) and improved to 16.1 points (±16.5 points) after 6 months, while in the open group it enhanced after 6 months (19.5 points [±17.5 points]) compared to its preoperative value by 38.2 points (±24.1 points). A consistent improvement was found for NRS, which decreased after surgery in both groups (arthroscopic group = −3.1 [±3.0]; open group = −2.0 [±2.9]). Complications did not occur in either group. When comparing delta values of the groups between the preoperative ROM, DASH score, and NRS, no significant differences were observed (p < 0.05). Conclusions Good to excellent functional recovery was seen in both cohorts when evaluating for improvement in the DASH score, the gain in elbow motion, and the decrease in pain. No significant differences were found between the procedures regarding pre- and postoperative measurements. The arthroscopic approach has developed to become an effective alternative to treat posttraumatic elbow stiffness.


2020 ◽  
Author(s):  
Giulia Masci ◽  
Gianpiero Cazzato ◽  
Giuseppe Milano ◽  
Gianluca Ciolli ◽  
Giuseppe Malerba ◽  
...  

Elbow stiffness is defined as any loss of movement that is greater than 30° in extension and less than 120° in flexion. Causes of elbow stiffness can be classified as traumatic or atraumatic and as congenital or acquired. Any alteration affecting the stability elements of the elbow can lead to a reduction in the arc of movement. The classification is based on the specific structures involved (Kay’s classification), anatomical location (Morrey’s classification), or on the degree of severity of rigidity (Vidal’s classification). Diagnosis is the result of a combination of medical history, physical examination (evaluating both active and passive movements), and imaging. The loss of soft tissue elasticity could be the result of bleeding, edema, granulation tissue formation, and fibrosis. Preventive measures include immobilization in extension, use of post-surgical drain, elastic compression bandage and continuous passive motion. Conservative treatment is used when elbow stiffness has been present for less than six months and consists of the use of serial casts, static or dynamic splints, CPM, physical therapy, manipulations and functional re-education. If conservative treatment fails or is not indicated, surgery is performed. Extrinsic rigidity cases are usually managed with an open or arthroscopic release, while those that are due to intrinsic causes can be managed with arthroplasties. The elbow is a joint that is particularly prone to developing stiffness due to its anatomical and biomechanical complexity, therefore the treatment of this pathology represents a challenge for the physiotherapist and the surgeon alike.


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