Elbow Stiffness
& Contracture
Jacksonville, FL
An elbow that won't straighten — or won't bend past 90° — after trauma, surgery, or prolonged immobilization. R. David Graham, MD at JOI performs open capsular release for post-traumatic and post-surgical elbow contracture when formal therapy has been exhausted. The elbow is one of the most stiffness-prone joints in the body, and capsular release can restore meaningful motion.
- Elbow stiffness most common after fracture, dislocation, or surgery
- Conservative: formal PT and dynamic/static progressive splinting first
- Surgical: open capsular release when >6 months of therapy has failed
- Both anterior (flexion contracture) and posterior (extension deficit) capsule addressed
- Heterotopic ossification assessed — may require concurrent excision
- Ulnar nerve decompression performed at same setting when indicated
The elbow is uniquely stiffness-prone. A flexion contracture of 30° or more — or loss of flexion past 100° — produces measurable functional deficit. Open capsular release can restore 30–50° of motion in appropriately selected patients.
Why the Elbow Gets Stiff
The Most Stiffness-Prone
Joint in the Body
The elbow is uniquely susceptible to stiffness after injury or surgery. The joint capsule, collateral ligaments, and surrounding soft tissues respond to trauma by forming dense adhesions and fibrotic contracture — a process that can significantly restrict the normal 0–145° arc of motion. Even brief periods of immobilization accelerate this process. The elbow does not forgive immobilization the way the shoulder or hip does.
Post-traumatic elbow contracture occurs after fractures (distal humerus, radial head, olecranon, coronoid), dislocations, and burns. Post-surgical contracture can follow any elbow operation if early motion is delayed. The resulting stiffness can be primarily a flexion contracture (inability to fully extend — loss of terminal extension), a flexion deficit (inability to flex past 90°), or combined.
Conservative management is always pursued first — formal hand therapy with dynamic and static progressive splinting, ultrasound, and aggressive active range-of-motion exercises. When 6 or more months of formal therapy has been exhausted without adequate progress, surgical capsular release is the next step.
Open capsular release addresses the anterior capsule (for flexion contracture — inability to extend) and the posterior capsule (for flexion deficit). Heterotopic ossification — ectopic bone in the soft tissues — is assessed on CT and excised at the same operation when it is mechanically blocking motion. The ulnar nerve is identified and decompressed or transposed at the same setting when cubital tunnel symptoms are present or when nerve mobilization is required for exposure.
- ✓ Flexion contracture >30° despite >6 months formal therapy
- ✓ Flexion limited to <100° with functional deficit
- ✓ Combined contracture limiting functional arc (<30–130°)
- ✓ Patient engaged in therapy and committed to post-op motion protocol
- ✓ Heterotopic ossification confirmed by CT — excised concurrently
- ✓ Adequate bone healing confirmed before capsular release
Open Capsular Release
Restoring the Functional Arc
Pre-operative Planning
CT scan evaluates for heterotopic ossification and confirms there are no bony blocks to motion that would prevent soft tissue release from being effective. Elbow X-rays assess joint congruence. The functional arc goal is established with the patient — typically targeting 30–130° or better.
Approach — Lateral or Combined
Open approach through a lateral (Kocher) or combined medial and lateral incision. The lateral approach allows access to both anterior and posterior capsule through a single incision in most cases. The radial nerve and posterior interosseous nerve are identified and protected.
Capsular Release
Anterior capsulectomy for flexion contracture — the anterior capsule is excised rather than simply incised, removing the contracted tissue. Posterior capsulectomy for flexion deficit — the posterior capsule and olecranon fossa are cleared of adhesions. Heterotopic bone is excised under direct visualization when present.
Ulnar Nerve — Assessed Every Case
The ulnar nerve is assessed for compression and subluxation. In-situ decompression or subcutaneous transposition performed when indicated — the same nerve handling principles as for cubital tunnel syndrome apply.
Immediate Post-op Motion
Continuous passive motion (CPM) machine initiated in the recovery room and continued through the first days post-operatively. Formal therapy begins within the first week. Dynamic splinting used to maintain gains between therapy sessions. The post-operative therapy commitment is as important as the surgery itself.
FAQs
Frequently Asked Questions
Related Conditions
Next Steps
Elbow that won't straighten
after months of therapy?
When formal therapy has been exhausted and the elbow contracture remains functionally limiting, open capsular release is the next step. Dr. Graham evaluates stiff elbows, reviews the therapy history, and discusses whether release is appropriate and what gains are realistic.
Jacksonville Beach, FL 32250
No imaging required.