Elbow Arhtrolysis for stiff elbow

describes a technique for open release

1. OPEN ARTHROLYSIS FOR A STIFF ELBOW BECAUSE OF AN UNUSUAL ETIOLOGY PRASHANT UPADHYAYA DNB RESIDENT UNIQUE SUPERSPECIALITY HOSPITAL INDORE JAYANT SHARMA M.S,D.N.B,M.N.A.M.S. www.drjayantsharma.com

2. THE PRESENCE OF THREE ARTICULATION WITH A SINGLE SYNOVIAL TISSUE LINED CAPSULE AND CLOSE PROXIMITY OF THE JOINT CAPSULE TO THE LIGAMENTS AND EXTRACAPSULAR MUSCLES AND THE INTRINSIC CONGRUITY OF HUMEROULNAR ARTICULATION PREDISPOSE TO STIFFNESS.

3. THE POSITION OF MINIMAL INTRAARTICULAR PRESSURE AND MAXIMUM COMPLIANCE OF NORMAL ELBOW(RESTING POSITION) IS 70 DEGREES. IF THE ELBOW IS IMMOBILIZED IN THIS POSITION FOR AN EXTENDED PERIOD OF TIME, THE RISK OF ELBOW JOINT CAPSULE, CONTRACTURE MIGHT INCREASE

4. CAUSES OF STIFFNESS INTRINSIC= INTRA ARTICULAR- POST TRAUMATIC ARTHR ITIS, INCONGRUITY,ANKYLOSIS,ADHESION,LOOSE BODIES, BONE SPURS, SYNOVITIS EXTRINSIC = HETEROTROPHIC OSSIFICATION, MUSCULOTENDINOUS CONTRACTURES

5. IF A PATIENT HAS AN EXTENSION DEFORMITY OF MORE THAN 30 DEGREE AND FLEXION OF LESS THAN 130 DEGREE FOR A PERIOD OF MORE THAN 6 MONTHS POST INJURY SHOULD BE CONSIDERED FOR ARTHROLYSIS.

6. PRESENT CASE OUR PATIENT WAS A FARMER, 35 YEAR OLD MALE WITH NO HISTORY OF ANY FRACTURE OR MAJOR TRAUMA. PRESENTED WITH RESTRICTED MOVEMENTS AT ELBOW AND TINGLING ALONG INNER SIDE OF FOREARM. GRADUALLY INCREASING OVER A PERIOD OF SIX MONTHS TOOK MASSAGE AND PHYSIOTHERAPY BOTH, WITH FURTHER INCREASE IN PAIN IN FRONT OF ELBOW

7. RESTRICTED EXTENSION(LAG) PASSIVE UPTO 80 DEGREES

8. ACTIVE EXTENSION LAG OF 70 DEGREES FLEXION OF 110 DEGREES

9. XRAY WAS NOT VERY CONCLUSIVE OF ANY MYOSITIS/ OLD FRACTURE MALUNION OLECRENON OSTEOPHYTOSIS NOTED AND SCLEROSIS AROUND RADIAL TUBEROSITY

10. MRI REVEALED LATERAL CONDYLAR DEGENERATION AND A ?SOFT TISSUE MASS IN SUPERIOR RADIOULNAR JOINT

11. OPEN ARTHROLYSIS PERFORMED USING EXTENSIVE LATERAL AND MEDIAL INCISION. LATERAL APPROACH- RELEASE CAPSULE, LATERAL COLLATERAL LIGAMENTS CUT. INTRA ARTICULAR GANGLION FOUND AT THE LEVEL OF SUPERIOR RADIOULNAR JOINT. TRICEPS AND BRACHIALIS TENOLYSIS DONE INTRA ARTICULAR GANGLION

12. AFTER RELEASE OF TIGHT BAND ULNAR NERVE WAS RELEASED AND ANTERIORLY TRASNSPOSED IN A FASCIAL TUNNEL CREATED. ULNAR NERVE

13. POST OPERATIVE ASSESMENT OF RANGE OF MOTION IS DONE ON TABLE

14. POST OPERATIVE PROTOCOL STITCH REMOVAL ON 10 TH POST OPERATIVE DAY ACTIVE RANGE OF MOVEMENT EXERCISES STARTED ELBOW MOBILIZATION BRACE GIVEN PHYSIOTHERAPY WAS THE MAIN STAY IN OBTAINING EXCELLENT RESULT

15. AT THE END OF SIX MONTHS THE RANGE OF MOTION WAS ASSESED WITH ALMOST FULL FUNCTIONAL LEVEL OF EXTENSION AND FLEXION ARCH. VAS OF THE PATIENT WAS BETWEEN 0 TO 2 FOR TOUCH ,PIN PRICK AND PRESSURE.

16. REFERENCES