Three bones come together to make up the elbow. These bones are the arm bone (humerus) and two forearm bones (radius and ulna). The bones have very distinct shapes so that they fit together closely. The elbow joint is further stabilized by ligaments that helps hold the bones together. Strong, flexible connective tissue surrounds the joint, and is known as the elbow capsule. In some patients, this capsule can become very thickened and inflamed, significantly limiting motion and causing substantial pain.
Elbow stiffness, or decreased range of motion, can be caused by either a thickened capsule, or by extra bone bumps called osteophytes. Patients who have had trauma or injuries to the elbow may develop a thickened capsule. Osteophytes primarily develop as a result of elbow arthritis. Patient with elbow stiffness describe pain or difficulty bending or straightening the elbow. Fortunately, the elbow functions well even if some range of motion is lacking.
If the elbow stiffness is mild, or has developed recently, physical therapy may help regain significant motion. If the stiffness is severe, has failed to improve with therapy, or is a result of arthritis, then surgery may be indicated. In some cases, surgery can as an outpatient using arthroscopic instruments in a minimally-invasive fashion. After anesthesia is given, multiple small incisions (under ¼" each) are made around the elbow. A camera (arthroscope) is placed in the elbow joint and using special instruments, the capsule is evaluated and released. Osteophytes are removed. The elbow is then taken through range of motion to ensure that full mobility has been restored. In other cases, a larger, open procedure is indicated, and an overnight hospital stay is recommended.
After surgery, the patient is immobilized in a splint overnight, and then physical therapy is begun the following day. Physical therapy is used to maintain the range of motion gained by releasing the elbow, and prevent scar tissue from re-accumulating and limiting elbow motion.