Normal elbow movements are essential for daily activities like eating, work, and other leisure pursuits. If their right is affected, it will be more difficult. Normal elbow movement is 0-150°. When the elbow is straight, it is 0 position and it is called as an extension. When the elbow is up to full, it is called as flexion. Elbow joints, one of the commonest joints in the body which gets injured in children and adults after a fall or after a director injury. When you fall from a bike or in stairs or on the street, we automatically tend to protect our body from falling on the outstretched hand are land on the tip of the elbow injuring it.
Very often, after the injury in the rural setup and also in the urban area people take it likely and go for native treatment. The post-traumatic stiffness of the elbow joint is one of the most common problems, we see in our day to day practice. All the more it is common in our country as most of the villages including learner people go in for native treatment even after X-rays being taken, because of fear of surgery, on the insistence of old folks at home and economic constraints.
Elbow movement of flexion and extension occur through the ulna humeral and radio-capitellar articulation along with the proximal radioulnar joint. The radio-capitellar articulations further provide an important interface to forearm rotation. This movement of rotation is important for eating, to receive something from with the hand or for any games.
CAUSES OF ELBOW STIFFNESS:
The important cause of the elbow stiffness is following an injury. The other cause is being myositis ossifications (New bone formation around the elbow joint). This may form commonly after a massage by native doctor head injury and burns. Other causes like tuberculous arthritis, rheumatoid arthritis, non-specific sub-acute infections and hemophilia must be ruled out.
AIM OF TREATMENT:
The main indication for elbow release surgery is stiffness that limits the activates of daily living. Especially on the right side for eating. Extension (bring the elbow into straight position) loss is better tolerated than flexion (taking the hand to mouth) loss. For release surgery (Arthrolysis), a normal articular surface is important.
This is important to know about the initial injury, period of immobilization (prolonged immobilization with plaster or by bamboo sticks, native medicines are bad for elbow joint) and previous history of surgical intervention.
The usable range of movements for elbow joint is 30“ to 130″. If an individual has this range of movement, a course of physiotherapy will suffice. But it must be done very carefully, sometimes it may become worse also.
To assess the joint anatomy regarding any old fracture and unreduced dislocation, articular congruity, presence and location of plates and screws, the presence of myositis mass and its location for the future plan for surgery. Sometimes CT scan and MRI may be necessary.
For the release of elbow stiffness surgery, it is important for the patient to know that they will get a usable range of movement and not a perfect joint movement. After the release of the contracted tissues around the joint (Arthrolysis) and removal myositic mass, it is mandatory the patient must co-operate for intensive physiotherapy. The pain during mobilization will be reduced by painkillers, ice back therapy, wax therapy and continuous passive motion machine CPM. Physiotherapist must be well experienced and patient’s cooperation is important.
Elbow release surgery (Arthrolysis) is a reward and it is done by an experienced surgeon. The role of physiotherapist is very important who is competent to give relief of pain and increase the range of movement after surgery. All the more essential is patient’s compliance and cooperation to get back the usable range of movement of 30“-l30°.
We always give a lot of moral support to get back the usable range of movement and tell them ‘Life is mobility, mobility is life’. Life is miserable to live with a stiff and painful elbow. There is always a cure for stiff elbow by surgical methods in the form Arthrolysis and rarely elbow joint replacement.