3 Months Old Post-Traumatic Stiff Elbow Following Terrible Triad Injury - A Case Report and Review of Literature

Stiff elbow is a common problem associated with terrible triad injuries which if not managed properly can lead to significant functional limitations. Here we are describing a case of post-traumatic stiff elbow following terrible triad who presented to us after taking native treatment primarily. He was treated with open arthrolysis and prophylactic ulnar nerve decompression along with rigorous physiotherapy including dynamic splinting with hinge elbow bracing. The results were satisfactory in achieving a functional range of movement according to the patient's vocational need. This study aims to present the prompt management of post-traumatic stiff elbow case along with functional improvement postoperatively in a decisive way. Terrible triad injuries are a group of the rare and severely unstable fracturedislocations following which the chance of recurrent instability, elbow stiffness, and functional limitations increases coherently.1 To perform normal daily activities, painless motion at the elbow joint is very much necessary and critical. Following a traumatic insult, a cascade of events can lead to a decrease in the normal arc of motion and also cause stiffness of the elbow joint.2 Over the last two decades, there has been a lot of speculation revolving around the management of terrible triad injuries.3 Van Riet et al had documented that the majority of the terrible triad injuries need to be managed surgically whereas the non-operative treatment is reserved for a few selected cases. 4 The ones which were not managed adequately had higher chances of turning up into stiff elbow. Post-traumatic elbow stiffness is one of the dreaded complications following terrible triad injuries.3 The aim of managing the case of post-traumatic stiff elbow is to have a painless, near-normal range of motion which can help the patient to do daily activities by himself. We are presenting a case of post-traumatic type- 4 stiff elbow following native bandage treatment and how prompt management has led to satisfactory results.

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Short-term effect of ultrasound therapy on stiffness elbow joint

Iraqi Journal of Physics (IJP) ◽

10.30723/ijp.v12i25.308 ◽

2019 ◽

Vol 12 (25) ◽

pp. 89-93

Author(s):

Fezaa Sh. Neda

Keyword(s):

Elbow Joint ◽

Ultrasound Therapy ◽

Joint Movement ◽

Elbow Stiffness ◽

Range Of Movement ◽

Stiff Elbow ◽

Wide Range ◽

Post Traumatic ◽

Movement Angle ◽

Flexion And Extension

Elbow stiffness is hard to treat and commonly resulted from trauma or degenerative arthritis. This study aimed to demonstrate the effectiveness of using ultrasound therapy in management of stiff elbow joint resulted from several etiological factors. A total number of 42 patients (35 male and 7 female) allocated randomly from the Department of Physiotherapy at Al-yarmouk Teaching Hospital during 2013. Each patient examined physically by physiotherapist taking in consideration the measurement of the joint movement angle using goniometer in flexion and the extension, and the pain score using visual analogue scale (VAS). Ultrasound therapy initiated thrice weekly for two weeks. At the time of entry, the means degree of flexion and extension movements were 148.45 and 113.33º. Ultrasound therapy significantly reduced the pain from of 1.238±0.932 to 0.38± 0.538score. Significant improvement observed in patients aged more than 20 years and the improvement in flexion elbow significantly correlated with the frequency of ultrasound. In Conclusions ultrasound therapy is safe, effective and provided pain relieve as well as wide range of movement in post-traumatic elbow stiffness.

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Post-traumatic elbow stiffness: Pathogenesis and current treatments

Shoulder & Elbow ◽

10.1177/1758573218793903 ◽

2018 ◽

Vol 12 (1) ◽

pp. 38-45 ◽

Cited By ~ 3

Author(s):

Dafang Zhang ◽

Ara Nazarian ◽

Edward K Rodriguez

Keyword(s):

Treatment Options ◽

Nonoperative Treatment ◽

Upper Extremities ◽

Elbow Stiffness ◽

Open Arthrolysis ◽

Future Directions ◽

Manipulation Under Anesthesia ◽

Stiff Elbow ◽

Pros And Cons ◽

Post Traumatic

Post-traumatic elbow stiffness is a major cause of functional impairment after elbow trauma. A stiff elbow limits patients’ ability to position their hand in space for optimal use of their upper extremities, and as such, is a frequent indication for reoperation. This article reviews current concepts on the pathogenesis of post-traumatic elbow stiffness. Current nonoperative treatment options include therapy, bracing, and manipulation under anesthesia, while operative treatment options include arthroscopic and open arthrolysis. The pros and cons of various treatment options are discussed, with a focus on the evidence supporting their use, the expected functional gains, and associated complications. Future directions in post-traumatic elbow stiffness are highlighted.

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A prospective comparison of short-term results after arthroscopic and open elbow procedures in elbow stiffness

Obere Extremität ◽

10.1007/s11678-019-00544-1 ◽

2019 ◽

Vol 14 (4) ◽

pp. 263-268 ◽

Cited By ~ 1

Author(s):

T. Leschinger ◽

M. Hackl ◽

M. Lenz ◽

V. Rausch ◽

L. P. Müller ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Dash Score ◽

Open Approach ◽

Elbow Stiffness ◽

Short Term ◽

Open Arthrolysis ◽

Stiff Elbow ◽

Prospective Comparison ◽

Elbow Movement

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.

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The influence of body mass index on outcome of open arthrolysis for post-traumatic elbow stiffness

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2016.12.065 ◽

2017 ◽

Vol 26 (5) ◽

pp. 809-814 ◽

Cited By ~ 4

Author(s):

Wei Zheng ◽

Shuai Chen ◽

Jialin Song ◽

Jiazhi Liu ◽

Cunyi Fan

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Elbow Stiffness ◽

Open Arthrolysis ◽

Post Traumatic

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Impact of Smoking on Clinical Outcomes of Open Arthrolysis for Post-Traumatic Elbow Stiffness

Journal of Bone Research ◽

10.4172/2572-4916.1000184 ◽

2017 ◽

Vol 05 (03) ◽

Author(s):

Ziyang Sun ◽

Cunyi Fan ◽

Hao Xiong

Keyword(s):

Clinical Outcomes ◽

Elbow Stiffness ◽

Open Arthrolysis ◽

Post Traumatic

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Open elbow arthrolysis for post-traumatic elbow stiffness

Bone & Joint Open ◽

10.1302/2633-1462.19.bjo-2020-0098.r1 ◽

2020 ◽

Vol 1 (9) ◽

pp. 576-584 ◽

Cited By ~ 1

Author(s):

Ziyang Sun ◽

Weixuan Liu ◽

Juehong Li ◽

Cunyi Fan

Keyword(s):

Upper Limb ◽

Conservative Therapy ◽

Preoperative Evaluation ◽

Diagnosis And Treatment ◽

Elbow Stiffness ◽

Postoperative Rehabilitation ◽

Stiff Elbow ◽

Post Traumatic ◽

Elbow Arthrolysis

Post-traumatic elbow stiffness is a disabling condition that remains challenging for upper limb surgeons. Open elbow arthrolysis is commonly used for the treatment of stiff elbow when conservative therapy has failed. Multiple questions commonly arise from surgeons who deal with this disease. These include whether the patient has post-traumatic stiff elbow, how to evaluate the problem, when surgery is appropriate, how to perform an excellent arthrolysis, what the optimal postoperative rehabilitation is, and how to prevent or reduce the incidence of complications. Following these questions, this review provides an update and overview of post-traumatic elbow stiffness with respect to the diagnosis, preoperative evaluation, arthrolysis strategies, postoperative rehabilitation, and prevention of complications, aiming to provide a complete diagnosis and treatment path. Cite this article: Bone Joint Open 2020;1-9:576–584.

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