Patients › Elbow

Stiff Elbow Release (Arthrolysis)

Updated Sep 20265 citations

Why this operation has been suggested¶

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At your appointment we take a history, examine your elbow and arrange imaging if needed. A stiff elbow often improves with time and use, so we usually try non-operative care first. This may include physiotherapy, splinting or injections over 6 to 12 weeks. Surgery is considered when that course has not given enough improvement.

Stiff elbow release, also called arthrolysis, is an operation that frees the tight, scarred tissue around your elbow so the joint can move again. We suggest it when stiffness is still limiting you after non-operative treatment. It works best when the joint surface is still smooth and in its normal shape. The aim is a lasting gain in movement and less pain, so daily tasks become easier.

Before the operation¶

Once surgery is planned, there are a few practical things to sort out. You will be told when to stop eating and drinking: this is seven hours before your operation. We ask for seven hours rather than six so that, if the theatre list runs early, we can bring you forward. Your surgeon will tell you which of your usual medicines to stop and when, and you should bring a full list of them with you. Arrange for someone to drive you home afterwards. Wear loose, comfortable clothing on the day. X-rays are always taken to plan the operation, and a CT scan may be used if the stiffness involves bone. If you have other medical conditions, you may need blood tests or a review with the anaesthetist.

On the day¶

You arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You meet the anaesthetist there. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day. You are then taken into the operating theatre, where the operation is performed.

You wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery.

What the operation involves¶

There is more than one way to release a stiff elbow, and your surgeon will choose the approach that suits your elbow. Some releases are done through keyhole surgery, using a few small cuts and a thin camera. Others are done through one or two open cuts, sometimes about 3 to 5 cm long, on the inner or outer side of the elbow. For very stiff elbows, a cut at the back of the elbow may be used to reach both sides.

Once inside, your surgeon frees the tight capsule, which is the sleeve of tissue around the joint. Bone spurs that block movement are trimmed away, and any loose fragments of bone or cartilage floating in the joint are removed. If a nerve on the inner side of the elbow is squeezed by scar tissue, it may be freed from that tunnel of tissue, or moved to a new position where it cannot be stretched. If the joint surface itself is badly worn, other options exist, such as lining the bone with soft tissue or replacing the joint surfaces with metal and plastic parts. Sometimes a hinged frame is fitted to the elbow to hold the joint in a good position while it heals.

At the end, the cuts are closed with stitches and covered with a dressing. You will keep that dressing on for about 10 days, as described in the recovery section.

After the operation¶

You wake up in the recovery area, then move to the ward. Nurses will check your elbow, your hand and how you are feeling. Pain relief is given as you need it; tell the nurses if your elbow is uncomfortable. Your elbow will be wrapped in a soft dressing, and you may go home with your arm in a sling for comfort. You can get out of bed and move around soon after, and the nurses will help you the first time. Your hand, wrist and shoulder can move freely while your elbow settles. Someone should stay with you for the first 24 hours after you go home. Your team will tell you whether you go home the same day or stay one night in hospital. We leave the dressing on for about 10 days; please do not take it off before then unless we tell you to. We change or remove it when we see you.

Recovery¶

Your elbow will be sore and swollen for the first days and weeks. This is normal after a release. Rest, keeping your hand raised and taking your pain relief as prescribed will ease the discomfort. The swelling settles gradually, and as it does, the elbow usually feels less tight.

You will go home with your arm in a sling for comfort. You can stop using it once it no longer helps. Your hand, wrist and shoulder should keep moving freely from the start. Hand therapy after surgery is with Ruby Doolan at Extend Rehabilitation. Ruby will guide your exercises and make any splint you need. The exercises are the main work of your recovery, and doing them as directed matters more than anything else. You will keep the dressing on for about 10 days, and we will change or remove it when we see you.

Everyday tasks will come back in stages. At first you will need help with cooking, dressing and carrying things. As movement returns and the swelling settles, you will manage more with the operated arm. Once your surgeon clears you to drive, you can return to the road; our guide to driving after upper-limb surgery explains the rules that apply, including not driving while your arm is in a sling and being off strong pain medication.

Recovery varies from person to person. Your timeline may differ, and your surgeon and therapist will guide you along the way.

What can go wrong¶

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

The longer an elbow has been stiff, the more likely problems become after a release. If your elbow has been stiff for a long time, your surgeon will talk this through with you before you decide.

One thing some people notice afterwards is new tingling, numbness or weakness in the little and ring fingers. This comes from the nerve on the inner side of the elbow. It is not always possible to predict who will get this. If you notice these feelings, mention them at your next review, or call the clinic if they come on suddenly.

Some elbows that have been injured before carry a higher chance of a deep infection afterwards. Watch the wound for redness that spreads out from it, warmth, increasing swelling, or a deep, throbbing pain that does not ease with simple painkillers. You may feel feverish or generally unwell. If you see any of these signs, call the clinic straight away, or go to the emergency department if it is after hours.

If your operation involves a hinged frame fitted to the elbow, there are a few extra things to know. The frame adds to the blood loss during surgery, the time in theatre and the time in hospital. It also carries a small chance of the joint becoming loose or unstable. Your surgeon will explain what this means for your stay and your recovery.

If you have had operations on this elbow before, the chance of a deep infection is higher again. The same applies when the operation itself is more complex. Your surgeon weighs all of this up with you beforehand.

Long-standing elbow injuries can also change the way the joint works. Scarred skin, bones that have healed out of place, damaged cartilage, extra bone, loose or tight ligaments, squeezed nerves and scarred muscle can all alter how the elbow moves. Your surgeon will look for these when planning your operation.

The complications table on this page lists typical rates if you want the specifics.

When to call us¶

Call us if you notice fever, spreading redness around the wound, discharge from the wound, or pain that keeps getting worse. Go to emergency if you have sudden severe pain, calf swelling or pain, or shortness of breath. Call us straight away if your hand or fingers go numb or pale, or if you cannot move your arm. If tingling or numbness in the little and ring fingers comes on suddenly, call the clinic rather than waiting for your next review.

In more depth¶

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Releasing a stiff elbow is worth the extra reading because the evidence points somewhere unusual: the choice most patients ask about, keyhole or open, appears to matter less than how much surgery is done, and the operation's real adversary is the same process that caused the stiffness in the first place.

Open or arthroscopic is not the important question¶

A systematic review and meta-analysis of 4,311 patients with post-traumatic elbow stiffness compared open with arthroscopic arthrolysis and found the overall results comparable [1]. Its conclusion was that the surgeon's expertise and the patient's particular condition are more important considerations than the technique itself [1].

That is an unusually direct statement for a systematic review, and it is worth taking at face value. This is a technically demanding operation performed close to three major nerves in a joint whose capacity is already reduced by the contracture being treated. Familiarity with the approach is doing more work than the approach.

Less surgery, fewer problems¶

An earlier systematic review of 798 patients reached a conclusion that has held up: the number of complications appears to rise with the extent of the surgical procedure, and the advice that follows is to treat as little invasively as possible [2]. The authors graded that recommendation modestly, the literature is not strong enough for a firm statistical conclusion, but the direction is consistent.

This is the tension at the centre of the operation. A more complete release buys more motion on the operating table, and costs more soft-tissue trauma, more bleeding into the joint, and more inflammatory stimulus, the raw materials for the stiffness returning.

Heterotopic ossification is the thing to prevent¶

Heterotopic ossification, where bone forms in soft tissue that should stay flexible, is the mechanism by which a released elbow stiffens again. Prophylaxis with anti-inflammatories is standard, though the evidence is thinner than the practice.

A meta-analysis of 622 patients comparing COX-2 selective against nonselective anti-inflammatories after elbow trauma surgery found that both effectively reduce the risk of heterotopic ossification, while individual head-to-head comparisons showed no statistically significant difference between them, and the overall power of the evidence was low [3]. So: prophylaxis appears worthwhile, the choice of agent is not clearly consequential, and the certainty is limited.

Context helps set expectations. After total elbow arthroplasty, heterotopic ossification is an uncommon complication, and where it develops most patients are asymptomatic and need no surgery for it, to the point that routine prophylaxis after that operation is not supported by the literature [4]. The risk is not uniform across elbow surgery; it is concentrated in trauma and in extensive releases.

One intervention that does not do what you would expect¶

Tranexamic acid reduces bleeding in many orthopaedic operations, and reducing bleeding into a freshly released elbow sounds like it should reduce stiffness. A meta-analysis of 660 patients found that tranexamic acid may indeed reduce bleeding volume during open elbow arthrolysis, but that it did not affect final range of motion or pain scores [5].

It is a clean example of a plausible mechanism failing to translate into the outcome anyone cares about, and a reminder that "less bleeding" is a surrogate, not a result.

What actually determines your outcome¶

Nothing in this literature suggests a technical shortcut. The consistent signals are that the operation should be no larger than it needs to be, that prophylaxis against heterotopic ossification is worth taking, and that the motion gained in theatre is only retained through the rehabilitation that follows. The elbow is unusually willing to stiffen; the months after the release matter at least as much as the release.

References for the advanced reading

Khorram R, Ghayyad K, Vafadar R, Borazjani R, Nezameslami A, Huffman GR, et al. Surgical treatments of post-traumatic elbow stiffness: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2026;35(1):387-407.
Kodde IF, van Rijn J, van den Bekerom MP, Eygendaal D. Surgical treatment of post-traumatic elbow stiffness: a systematic review. J Shoulder Elbow Surg. 2013;22(4):574-80.
Ahmad A, Khorram R, Ghayyad K, Amin V, Kachooei AR, Huffman GR, et al. Postoperative nonsteroidal anti-inflammatory drug prophylaxis for elbow heterotopic ossification: a systematic review and meta-analysis comparing COX-2 selective and nonselective inhibitors. JSES Rev Rep Tech. 2026;6(2):100628.
Liu EY, Hildebrand A, Horner NS, Athwal GS, Khan M, Alolabi B. Heterotopic ossification after total elbow arthroplasty: a systematic review. J Shoulder Elbow Surg. 2019;28(3):587-95.
Nejat MH, Khayami A, Daliri M, Ebrahimzadeh MH, Sadeghi M, Moradi A. Does tranexamic acid diminish hemorrhage and pain in open elbow arthrolysis? A systematic review and meta-analysis. BMC Musculoskelet Disord. 2023;24(1).

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

In the setting of failed nonsurgical treatment of the stiff elbow, surgical release can yield sustained improvement of range of motion and patient quality of life [1].
Treatment choices for elbow stiffness must consider non-surgical management and various surgical options including arthroscopic or open capsular release, arthroplasty, and elbow replacement [2].
Arthroscopic capsular release of the elbow is effective for restoring a functional arc of motion in the short term in most patients with extrinsic contractures [3].
Arthroscopic elbow contracture release can improve function and range of motion, though outcomes may vary based on preoperative patient characteristics [4].
Current literature provides state-of-the-art guidance on the management regarding prevention, evaluation, and treatment of elbow stiffness [5].
Patients with stiff elbows who underwent arthroscopic arthrolysis achieved satisfactory clinical outcomes very early postoperatively [7].
Current treatment options for post-traumatic elbow stiffness range from conservative to surgical, with varying rates of success, invasiveness, and complications [8].
A multinational initiative provides the first comprehensive clinical practice guideline for open arthrolysis in adult posttraumatic elbow stiffness [9].
A subset of pediatric patients with persistent stiffness following medial epicondyle fractures may benefit from additional interventions, including intensive therapy, transposition of the ulnar nerve, and open capsular release [13].
In most cases, the current use of arthroscopy by experienced surgeons will produce results superior to those of open release given the proper indications [14].
The use of a hinged external fixator in open arthrolysis for posttraumatic elbow stiffness may result in short-term improvements in flexion-extension range of motion [16].
The use of a hinged external fixator in open arthrolysis for posttraumatic elbow stiffness is accompanied by increased blood loss, longer operative time, extended hospitalization, and higher costs [16].
The dual mediolateral mini-open technique allows for a safe and effective release of stiff elbows through small incisions of 3–5 cm in length [18].

Anatomy & Pathophysiology¶

Bony Anatomy¶

The elbow is a trocho-ginglymoid joint consisting of medial and lateral articulations that provide bony stability [28].
The medial articulation involves the trochlea and the ulna within the greater sigmoid notch, forming the ulnohumeral hinged portion [28].
The ulnohumeral articulation features highly congruent anatomy through almost 180° of articular contact, except for a bare area of the greater sigmoid notch devoid of cartilage [28].
The coronoid process has medial and lateral facets that buttress the trochlea anteriorly [28].
The sublime tubercle is located just distal and medial to the coronoid and serves as the attachment site for the anterior bundle of the medial ulnar collateral ligament [28].
The lateral articulation involves the capitellum and radial head, forming the radiocapitellar joint [28].
The radius is held in close approximation to the ulna at the proximal radioulnar joint by the annular ligament [28].
The radial head is a concave elliptical structure covered with articular cartilage along the radiocapitellar joint and approximately 270° of the articular margin [28].
The distal humeral articulation is angled 30° from the longitudinal axis [28].
The axis of rotation is angulated 5° to 7° in the coronal plane relative to the epicondylar axis, with the medial side more distal than the lateral side [28].
The ulna medially bends approximately 8° at 8 cm from the tip of the olecranon [28].
The articulation to the tip of the coronoid is approximately 30° from the long axis of the ulna in the sagittal plane [28].

Ligaments and Soft Tissue¶

Elbow stability is determined by primary stabilizers (ulnohumeral articulation, MUCL, LUCL complex) and secondary stabilizers (radiocapitellar articulation, common flexor tendon, common extensor tendon, joint capsule) [25].
The medial ulnar collateral ligament is the primary valgus stabilizer of the elbow [29].
The anterior bundle of the medial ulnar collateral ligament is the most important component for stability [29].
The posterior bundle of the medial ulnar collateral ligament becomes taut at flexion beyond 120 degrees [29].
The lateral ulnar collateral ligament serves as the posterolateral stabilizer of the elbow [29].
Osborne’s ligament stabilizes the ulnar nerve in the cubital tunnel [29].
The ligament of Struthers is a variant anatomy arising from the supracondylar process to attach to the medial epicondyle and is a potential site of median nerve compression [29].
The joint capsule allows maximum distension at approximately 70 to 80 degrees of flexion [29].
The anterior capsule attaches at a point approximately 6 mm distal to the tip of the coronoid [29].
Tensile forces are present at the medial elbow, while compressive forces are present at the lateral elbow [29].

Muscles¶

The brachialis is the strongest elbow flexor and attaches to the coronoid 11 mm distal to the tip [29].
The biceps brachii inserts at the ulnar margin of the radial tuberosity and acts as a powerful supinator of the forearm [29].
The triceps brachii is the primary elbow extensor and inserts on the olecranon process [29].
The mobile wad consists of the brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis [29].
The flexor-pronator mass includes the pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis [29].

Pathophysiology and Functional Range¶

The normal elbow has a range of motion from 0° to 140° from extension to flexion [25].
The normal elbow has a range of motion of 75° in pronation and 85° in supination [25].
A functional arc of motion for the elbow is 100° for flexion and extension [25].
A functional arc of motion for the elbow is 100° for forearm rotation [25].
Successful intervention for a stiff elbow depends on the quality of the joint and the extent of soft tissue damage [11].
The functional arc of motion serves as a frame of reference rather than an absolute goal for stiff elbow treatment [11].
Treatment of the stiff elbow requires a thorough understanding of normal anatomy and etiological factors to develop effective strategies [10].

Classification¶

The S.T.I.F. classification system highlights the aetiology of elbow stiffness [51].
The S.T.I.F. classification system provides a framework to better understand the natural history of elbow stiffness [51].
The S.T.I.F. classification system provides a framework to direct surgical management of elbow stiffness [51].
The S.T.I.F. classification system provides a framework to predict clinical outcomes for elbow stiffness [51].
Influencing factors must be taken into consideration for proper surgical indication and prognosis when using the S.T.I.F. classification system [51].
The S.T.I.F. classification system is beneficial for research because identifying homogenous patterns of stiffness allows for more appropriate comparison between different treatment options [51].
Based on the S.T.I.F. classification system, a treatment algorithm can be proposed that includes the severity of the disorders as a guide to surgical treatment [51].
Based on the S.T.I.F. classification system, a treatment algorithm can be proposed that includes the severity of the disorders as a guide to the preferred operative approach (open or scope) [51].
The prevalent types of stiffness identified by the S.T.I.F. classification system could be applied in the future to Artificial Intelligence to help in diagnosing the cause of elbow stiffness [51].

Clinical Presentation¶

Elbow stiffness is a challenging problem with no ideal management solution [6].
Elbow contracture is challenging to treat, and therefore prevention is of paramount importance [17].
Restoration of joint motion in the posttraumatic stiff elbow can be a difficult, time-consuming, and costly challenge [15].
Successful intervention for stiff elbow depends on the quality of the joint and the extent of soft tissue damage [11].
The functional arc of motion serves as a frame of reference rather than an absolute goal for stiff elbow intervention [11].
Conservative treatment is indicated for patients that have elbow stiffness due to heterotopic ossification for less than six months [22].
Current non-surgical treatment measures for elbow stiffness due to heterotopic ossification include physical therapy and manipulation under anesthesia in order to restore the range of motion of the involved joint [22].
Non-surgical options for heterotopic ossification have limited effects and can be used mainly in cases that cause a small limitation of range of motion [22].
Surgical options are necessary if nonoperative management fails to restore the elbow function and range of motion after 6 months in patients with heterotopic ossification [22].
Surgical excision of ectopic bone and contracture release, if present, are the most common surgical options in elbow heterotopic ossification management [22].
Arthroscopic elbow contracture release can improve function and range of motion, although outcomes may vary based on preoperative patient characteristics [4].
Although both open and arthroscopic techniques may produce satisfactory results, the current use of arthroscopy by experienced surgeons will produce results superior to those of open release given the proper indications [14].
Operative management of pediatric elbow contractures is effective [23].
Patients undergoing operative management of elbow stiffness secondary to heterotopic ossification maintained substantial reductions in pain, improvement in elbow range of motion, and increased overall elbow function [12].
Treatment of bony encasement of the ulnar nerve secondary to heterotopic ossification of the elbow leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes [24].
Delayed-onset anterior interosseous nerve palsy can develop one week after open elbow contracture release, likely due to a stretch injury [26].

Investigations¶

History and Physical Examination¶

The history for elbow stiffness evaluation includes the duration of the contracture, initial injury, previous surgical procedures, trials of splinting/therapy/injections, surgical complications, and patient work/life demands [34].
Physical examination must assess the function of the shoulder, wrist, and hand [34].
The soft tissue surrounding the elbow should be examined for previous skin incisions, grafts, eschar, or infection [34].
Active and passive flexion, extension, supination, and pronation should be evaluated using a goniometer for accurate measurement [34].
The contralateral elbow should be examined for comparison during range of motion assessment [34].
If the elbow has less than 90° to 100° of flexion, the posterior bundle of the medial collateral ligament is contracted and must be released to restore flexion [34].
Pain assessment during the mid-arc or at terminal ends of motion helps distinguish intrinsic disease from contracture, as mid-arc pain is more common with intrinsic disease and may not improve with contracture release alone [34].
The ulnar nerve is of utmost importance in the neurovascular examination due to its anatomic proximity to the elbow [34].
Electromyography and nerve conduction velocity studies should be performed if there is any question about neurologic dysfunction [34].
An assessment for ulnar nerve subluxation should be performed, as subluxation is a relative contraindication for arthroscopic procedures due to the risk of iatrogenic nerve injury [34].
The surgeon must verify if the ulnar nerve has been transposed if there is a history of prior surgical procedures [34].
Successful intervention for stiff elbow depends on the quality of the joint and the extent of soft tissue damage, with the functional arc of motion serving as a frame of reference rather than an absolute goal [11].

Imaging¶

Radiographs should always be obtained for the evaluation of elbow stiffness [34].
Standard radiographic views include AP, lateral, and oblique views, with serial radiography used as follow-up when heterotopic ossification is present [34].
Primary bony landmarks assessed on radiographs include the ulnohumeral joint, coronoid process, radial head, capitellum, radiocapitellar joint, olecranon tip, coronoid/olecranon fossae, and trochlear ridge [34].
CT is helpful for assessing malunion architecture and the location and pattern of osteophytes or loose bodies [34].
Three-dimensional CT is used to check for heterotopic ossification [34].
CT is not necessary when the stiffness is entirely soft-tissue related, but is beneficial if any joint incongruity or abnormal bony anatomy is present [34].
MRI can be used to evaluate ligaments and tendons but is rarely indicated for elbow stiffness [34].
The normal elbow has a range of motion from 0° to 140° from extension to flexion and 75° and 85° in pronation and supination respectively [25].
A functional arc in each plane is 100° for flexion and extension and forearm rotation [25].
Elbow stability is determined by primary stabilizers (ulnohumeral articulation, MUCL, LUCL) and secondary stabilizers (radiocapitellar articulation, common flexor tendon, common extensor tendon, joint capsule) [25].

Treatment¶

General Principles and Indications¶

Elbow stiffness is a challenging problem with no ideal management solution; however, functional improvements can be achieved with both nonsurgical and surgical strategies [6].

Arthroscopic Release¶

Arthroscopic elbow contracture release can improve function and range of motion; however, outcomes may vary based on preoperative patient characteristics [4].
Although both open and arthroscopic techniques may produce satisfactory results, the authors believe that in most cases the current use of arthroscopy by experienced surgeons will produce results superior to those of open release given the proper indications [14].
Additional peripheral nerve block combined with a postoperative nerve block catheter in arthroscopic arthrolysis in cases of elbow stiffness may be an opportunity to enhance postoperative outcomes by achieving better functional ROM, perhaps through reduced postoperative pain [48].

Open Release and Techniques¶

This multinational initiative provides the first comprehensive clinical practice guideline for open arthrolysis in adult posttraumatic elbow stiffness [9].
The use of a hinged external fixator in open arthrolysis for posttraumatic elbow stiffness may result in short-term improvements in flexion-extension range of motion but is accompanied by increased blood loss, longer operative time, extended hospitalization, and higher costs [16].
The most common reason for a failed contracture release is a failure on the part of the surgeon to abandon an orthodox method in favor of a less assured technique or to use a single anatomic approach to the joint when the potential gain in motion is not achieved at the time of surgery [40].
The operative contracture release requires a progressive, adaptive surgical approach, and the surgeon must safely increase the exposure in order to excise the offending fibrosis on nearly all aspects of the joint, anteroposterior and mediolateral [40].
If an uncomplicated, simple dislocation has caused a 30-degree flexion contracture, arthroscopic capsular excision may be sufficient [40].
The best care for a given patient with a contracture is the most minimal necessary surgery, including minimal anatomic exposure, and rehabilitation to achieve the desired result [40].
A patient with a range of 40 to 105 degrees and heterotopic ossification will usually require exposure of the capsule for complete excision from both the medial and lateral approaches but not necessarily hinged fixation [40].
In a circumstance with more massive heterotopic ossification, hinged external fixation may be necessary to stabilize the elbow postoperatively and permit immediate motion with intermittent passive stretch [40].
The surgeon should be prepared to extend the exposure or approach the joint from an additional direction if full passive motion is not achieved on the operating table [40].
In older patients with suspected cartilage damage or avascular bone, total elbow replacement should be available and discussed before surgery [40].

Outcomes and Complications¶

Overall, patients maintained substantial reductions in pain, improvement in elbow range of motion, and increased overall elbow function after operative management of elbow stiffness secondary to heterotopic ossification [12].
The gain in range of motion for open arthrolysis was 51° [19].
The gain in range of motion for arthroscopic arthrolysis was 40° [19].
The gain in range of motion for open arthrolysis with external fixation was 88° [19].
The gain in range of motion for open arthrolysis with distraction arthroplasty was 56° [19].
The average percentage of complications for open arthrolysis was 23% [19].
The average percentage of complications for arthroscopic arthrolysis was 5% [19].
The average percentage of complications for open arthrolysis with external fixation was 73% [19].
The average percentage of complications for open arthrolysis with distraction arthroplasty was 58% [19].

Complications¶

The use of a hinged external fixator in open arthrolysis is accompanied by increased blood loss [16].
The use of a hinged external fixator in open arthrolysis is accompanied by longer operative time [16].
The use of a hinged external fixator in open arthrolysis is accompanied by extended hospitalization [16].
The use of a hinged external fixator in open arthrolysis is accompanied by higher costs [16].
Current treatment options for post-traumatic elbow stiffness have varying rates of complications [8].

Recovery¶

Surgical release of the stiff elbow can yield sustained improvement of range of motion and patient quality of life in the setting of failed nonsurgical treatment [1].
Arthroscopic capsular release is effective for restoring a functional arc of motion in the short term in most patients with extrinsic contractures [3].
Functional improvements can be achieved with both nonsurgical and surgical strategies for elbow stiffness [6].
Treatment for bony encasement of the ulnar nerve secondary to heterotopic ossification of the elbow leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes [24].

Key Evidence¶

[L5] In the setting of failed nonsurgical treatment of the stiff elbow, surgical release can yield sustained improvement of ROM and patient quality of life. [1] (10.5435/jaaos-d-14-00051)
[L5] Treatment choices must consider non-surgical management and various surgical options including arthroscopic or open capsular release, arthroplasty, and elbow replacement. [2] (10.1016/j.jisako.2023.10.009)
[L5] Arthroscopic capsular release of the elbow is effective for restoring a functional arc of motion in the short term in most patients with extrinsic contractures. [3] (10.5435/00124635-201105000-00004)
[L4] Arthroscopic elbow contracture release can improve function and range of motion; however, outcomes may vary based on preoperative patient characteristics. [4] (10.1016/j.jseint.2026.101621)
[L4] This paper reviews the current literature and provides state-of-the-art guidance on the management regarding prevention, evaluation, and treatment of elbow stiffness. [5] (10.1530/eor-23-0039)
[L4] Elbow stiffness is a challenging problem with no ideal management solution; however, functional improvements can be achieved with both nonsurgical and surgical strategies, and recent advancements in biology and pathology may lead to future breakthroughs in prevention and treatment. [6] (10.1016/j.jhsa.2013.06.007)
[L1] Patients with stiff elbows who underwent arthroscopic arthrolysis achieved satisfactory clinical outcomes very early postoperatively. [7] (10.1016/j.jse.2024.06.009)
[L5] Current treatment options for post-traumatic elbow stiffness range from conservative to surgical, with varying rates of success, invasiveness, and complications. [8] (10.1177/1758573218793903)
[L5] This multinational initiative provides the first comprehensive clinical practice guideline for open arthrolysis in adult posttraumatic elbow stiffness. [9] (10.1016/j.jse.2025.07.015)
[L5] Treatment of the stiff elbow requires a thorough understanding of normal anatomy and etiological factors to develop effective strategies. [10] (10.1016/j.jisako.2023.10.006)
[L5] Successful intervention for stiff elbow depends on the quality of the joint and the extent of soft tissue damage, with the functional arc of motion serving as a frame of reference rather than an absolute goal. [11] (10.1016/j.jisako.2023.09.002)
[L4] Overall, patients maintained substantial reductions in pain, improvement in elbow range of motion, and increased overall elbow function. [12] (10.1016/j.jse.2024.11.019)
[L4] A subset of pediatric patients with persistent stiffness following medial epicondyle fractures may benefit from additional interventions, including intensive therapy, transposition of the ulnar nerve, and open capsular release. [13] (10.1016/j.jhsg.2023.07.002)
[L5] Although both open and arthroscopic techniques may produce satisfactory results, the authors believe that in most cases the current use of arthroscopy by experienced surgeons will produce results superior to those of open release given the proper indications. [14] (10.1016/j.jse.2010.11.029)
[L4] Restoration of joint motion in the posttraumatic stiff elbow can be a difficult, time-consuming, and costly challenge. [15] (10.1016/j.jhsa.2007.09.015)
[L3] The use of a hinged external fixator in open arthrolysis for posttraumatic elbow stiffness may result in short-term improvements in flexion-extension range of motion but is accompanied by increased blood loss, longer operative time, extended hospitalization, and higher costs. [16] (10.1186/s12891-024-08167-6)
[L5] Elbow contracture is challenging to treat, and therefore prevention is of paramount importance. [17] (10.1016/j.jhsa.2009.02.020)
[L4] The dual mediolateral mini-open technique allows for a safe and effective release of stiff elbows through small incisions of 3–5 cm in length. [18] (10.1186/s13018-025-06288-9)
[L4] [19] (10.1016/j.jse.2012.11.010)
[L4] [22] (10.3390/life13122358)
[L1] Operative management of pediatric elbow contractures is effective. [23] (10.1016/j.jhsa.2024.01.010)
[L4] This treatment approach leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes. [24] (10.1016/j.jse.2023.12.003)
[Case_report] The authors describe a case of delayed-onset anterior interosseous nerve palsy developing one week after open elbow contracture release, likely due to a stretch injury. [26] (10.5397/cise.2022.00899)
[L3] Additional peripheral nerve block combined with a postoperative nerve block catheter in arthroscopic arthrolysis in cases of elbow stiffness may be an opportunity to enhance postoperative outcomes by achieving better functional ROM, perhaps through reduced postoperative pain. [48] (10.1016/j.jseint.2024.10.009)
[L5] [51] (10.1016/j.jisako.2023.10.011)

References¶

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[2] Elbow stiffness: Arthritis and heterotopic ossification. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2023.10.009

[3] Arthroscopic Management of the Stiff Elbow. American Academy of Orthopaedic Surgeon. 2011. DOI: 10.5435/00124635-201105000-00004

[4] Preoperative risk factors associated with patient outcomes following arthroscopic elbow contracture release. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101621

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[7] Does tranexamic acid reduce elbow swelling and improve early function following arthroscopic arthrolysis? A double-blind randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.06.009

[8] Post-traumatic elbow stiffness: Pathogenesis and current treatments. Shoulder & Elbow. 2018. DOI: 10.1177/1758573218793903

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[10] The examination and treatment of soft tissue contracture of the elbow. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2023.10.006

[11] Elbow stiffness: Interview with professor Bernard Morrey. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2023.09.002

[12] Assessing long-term outcomes after operative management of elbow stiffness secondary to heterotopic ossification. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.11.019

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[14] Arthroscopic management of the post-traumatic stiff elbow. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.029

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[16] Comparative study of open elbow arthrolysis with and without hinge external fixation for the treatment of post-traumatic elbow stiffness. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-08167-6

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[18] Dual mediolateral mini-open technique for the release of elbow contracture. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06288-9

[19] Surgical treatment of post-traumatic elbow stiffness: a systematic review. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.11.010

[22] Heterotopic Ossification around the Elbow Revisited. Life. 2023. DOI: 10.3390/life13122358

[23] Clinical Outcomes Following Surgical Management of Post-Traumatic Elbow Contractures in the Pediatric Age Group: A Meta-Analysis and Systematic Review. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.01.010

[24] Bony encasement of the ulnar nerve secondary to heterotopic ossification of the elbow: an evaluation of long-term outcomes. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.12.003

[25] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Summary and Conclusions.

[26] Anterior interosseous nerve palsy in the early postoperative period after open capsular release for elbow stiffness: a case report. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2022.00899

[28] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Anatomy > Bony Anatomy.

[29] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > TABLE 2.3 Shoulder Spaces.

[34] Aaos Comprehensive Orthopaedic Review 3. Elbow Stiffness* > IV. Evaluation.

[40] Green S Operative Hand Surgery. Classifying the Contracture and Matching the Operative Plan.

[48] A comparative analysis of short-term results in range of motion following arthroscopic arthrolysis with vs. without peripheral nerve block in cases of elbow stiffness. JSES International. 2025. DOI: 10.1016/j.jseint.2024.10.009

[51] Classification of elbow stiffness. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2023.10.011

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