The pos-traumatic elbow stiffness is a comum problem and can interfere at patient‘s daily living activities. This affection has many causes and classically is treated with open methods, but we believe that the arthroscopic technique provides some advantages. Our propose in this study is to evaluate patient under arthroscopic surgery and to discuss its benefits and possible problems.
From february 2004 to July 2010, 34 arthroscopic releases were performed, but 10 of then were excluded due to don't fill the inclusion criteria. The procedure is done with general anesthesia, ventral decubitus and using a garrotte. The standart portals are used and the physiological solution is infused with a 30-40mmHg pressure and 50% or more flow rate. At immediate pos operative the elbow is immobilized in a removable cast or with an orthesis at the desired profit position for 6 weeks, being removed 4 to 6 times a day for movement and physiotherapy, which lengths 6 months. After that the patients were evaluated with the Mayo elbow score and manual analog goniometry.
The study group was composed by 15 men and 9 women, 14 right and 10 left elbows and the mean age 34,58 (18 to 62). The follow up varied from 18 to 62 months with average of 38,41. The ROM increased about 43,3 degrees (10 to 90) and the Mayo elbow score was 85,4 (25 to 100). We did not have any definitive iatrogenic injury, with one temporary paralysis of the posterior interosseus nerve.
The surgery for release of the stiff elbow is a well established procedure, with the open and the arthroscopic methods following the same principles. Against the closed way we have the longer learning curve, the costs and when muscles allonge is necessary and favourable is the aesthetic and lesser soft tissue aggression. Both modalities have the same possible complications. Concluding, the arthroscopic release for elbow stiffness besides providing ROM earning, gives great satisfaction rates and good cosmetic aspect. Each case must be individually evaluated and adjuvant procedures may be necessary. Take care with the surgical technique is always mandatory to avoid neurovascular injuries and with the correct indication it is a secure and effective procedure.
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.