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Stiff Elbow Release (Arthrolysis)

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Updated Aug 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. A clinic assessment establishes the diagnosis. For long-standing stiffness, we usually try non-operative care first and consider surgery when that has not given enough improvement.

This operation, known as elbow release or arthrolysis, loosens tight tissues to restore movement. We offer it when non-surgical treatments have failed to improve your range of motion or quality of life. The procedure aims to reduce pain and restore a functional arc of motion for daily tasks.

Before the operation

Please fast for seven hours before your surgery. This allows us to bring you forward if the theatre list runs early. Stop taking certain medications as advised by your surgeon, who will give you specific instructions. Arrange a lift home and wear comfortable clothing. Bring a list of your current medicines. We use imaging like X-rays, MRI, or ultrasound to plan your operation. If you have other medical conditions, you may need blood tests or a review with the anaesthetist. Most patients do not require these. Your surgeon will guide you through any necessary steps to ensure you are ready for the procedure.

On the day

You present to the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You meet the anaesthetist to discuss your care plan. 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

Your surgeon will likely use an arthroscopic approach, which involves making two or three small keyhole cuts about 1 cm each. Through these tiny openings, your surgeon inserts a camera and special instruments to look inside the joint. This minimally invasive method allows for a safe release of stiff tissues through small incisions of 3–5 cm in length if a mini-open technique is chosen instead.

Inside the elbow, your surgeon releases the tight bands of tissue and capsule that are trapping the joint and limiting your movement. This capsular release restores a functional arc of motion by freeing the structures that have become stiff. In some cases, additional steps such as moving the ulnar nerve to prevent irritation may be performed.

After the release is complete, your surgeon closes the small cuts with sutures or glue and applies a dressing. If your surgeon uses a hinged external fixator to help maintain movement, this device is attached to the outside of your arm. This fixator helps improve flexion and extension range in the short term, though it may lead to increased blood loss and a longer time in hospital.

For most patients with extrinsic contractures, this procedure effectively restores motion. Your surgeon will tailor the exact technique to your specific needs, ensuring the best possible outcome for your elbow stiffness.

After the operation

You will wake up in the recovery ward with your arm in a sling and a soft dressing. We manage pain using a nerve block catheter to keep you comfortable and help you move sooner. Your team will tell you whether you go home the same day or stay one night in hospital. Someone should stay with you for the first 24 hours to help you. We do not use rigid braces. You can gently move your fingers and wrist as tolerated. Keep the dressing clean and dry. Follow our advice on wound care. This approach supports sustained improvement in your elbow’s range of motion and quality of life.

Recovery

You can expect some swelling and discomfort in the days following your surgery. This is a normal part of healing. We manage this pain with medication and by keeping your arm elevated. Early movement helps reduce stiffness and improves your range of motion. Our hand therapist, Ruby Doolan at Extend Rehabilitation, guides your exercises. She also creates any splints you need to protect your elbow while you heal.

Your daily routine will focus on gentle movement. You will perform specific exercises to restore flexibility. We do not use hinged braces or rigid supports after this procedure. Instead, you will rely on your therapist’s guidance and your own comfort levels. Avoid heavy lifting or forceful gripping until your surgeon clears you. Sleep with your arm supported on pillows to keep swelling down.

As your movement returns, you will notice gradual improvements in function. You may drive once your surgeon confirms you are safe to do so. Please review our guide on driving after upper-limb surgery for universal safety rules. Your timeline may differ from others; your surgeon and hand therapist will guide you through each step of your recovery.

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.

Arthritis This is wear-and-tear of the joint lining. You might notice a deep ache inside the elbow that worsens with movement. The joint may feel stiff or grind when you bend or straighten it. If this pain persists or limits your daily tasks, bring it up at your next review. Your surgeon can discuss ways to manage the discomfort.

Heterotopic ossification This is extra bone growing in the soft tissues around the joint. You may feel a hard lump under the skin near the elbow. It can make the joint feel tight or blocked, reducing how far you can move it. If you notice new stiffness or a visible change in shape, contact the clinic. Your surgeon will assess whether this new bone is affecting your recovery.

Increased blood loss If your procedure involves a hinged external fixator, you may lose more blood than with other methods. You might feel unusually tired, dizzy, or short of breath after the operation. Your skin might look paler than usual. If you feel faint or excessively weak, seek medical attention promptly. The team will check your blood levels to ensure you are safe.

Longer operative time Using a hinged external fixator means the surgery takes longer. You will be under anaesthetic for a longer period. This can lead to more soreness and swelling in the immediate days after the procedure. Rest and follow your pain management plan. If swelling becomes severe or painful, contact the clinic for advice on managing it.

Extended hospitalization You may need to stay in hospital longer if a hinged external fixator is used. This is to monitor your recovery closely. You might feel frustrated by the extended stay, but it allows the team to ensure your elbow is stable. Use this time to ask questions and begin gentle movements as guided by our therapists.

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

When to call us

Call us if you have a fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling or shortness of breath. Contact us immediately if you experience loss of sensation or inability to move your limb. These signs need urgent assessment to ensure your recovery stays on track.

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. 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.

Reviewed by Dr Kieran Hirpara · 13 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References for the advanced reading
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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

  • Treatment choices for elbow stiffness must consider non-surgical management and various surgical options including arthroscopic or open capsular release, arthroplasty, and elbow replacement [1].
  • Arthroscopic elbow contracture release can improve function and range of motion, although outcomes may vary based on preoperative patient characteristics [2].
  • Current literature provides state-of-the-art guidance on the prevention, evaluation, and treatment of elbow stiffness [3].
  • Patients with stiff elbows who underwent arthroscopic arthrolysis achieved satisfactory clinical outcomes very early postoperatively [4].
  • 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 [5].
  • 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 [6].
  • A multinational initiative provides the first comprehensive clinical practice guideline for open arthrolysis in adult posttraumatic elbow stiffness [7].
  • Current treatment options for post-traumatic elbow stiffness range from conservative to surgical, with varying rates of success, invasiveness, and complications [11].
  • 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 [12].
  • 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 [13].
  • 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 [15].
  • 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 [17].

Anatomy & Pathophysiology

  • Elbow stiffness involves arthritis and heterotopic ossification [1].
  • Successful intervention for stiff elbow depends on the quality of the joint and the extent of soft tissue damage [9].
  • Treatment of the stiff elbow requires a thorough understanding of normal anatomy and etiological factors to develop effective strategies [16].
  • Endoscopic anterior capsulectomy is technically difficult and requires familiarity with neurovascular and musculoligamentous elbow anatomy [22].
  • Orthogonal plate configuration, olecranon osteotomy, and longer operative time are associated with increased odds of dysfunctional elbow stiffness following operative fixation of distal humerus fractures [24].
  • Progression of elbow flexion contracture in obstetric brachial plexus injury appears to level off after the age of 10 to 12 years, likely ending at skeletal maturity [29].

Classification

  • Management of the stiff elbow involves prevention, evaluation, and treatment strategies [3].
  • In the setting of failed nonsurgical treatment of the stiff elbow, surgical release can yield sustained improvement of ROM and patient quality of life [5].
  • Clinical practice guidelines exist for open arthrolysis in adult posttraumatic elbow stiffness [7].
  • Functional improvements in elbow stiffness can be achieved with both nonsurgical and surgical strategies [8].
  • The functional arc of motion serves as a frame of reference rather than an absolute goal in stiff elbow intervention [9].
  • Both open and arthroscopic techniques may produce satisfactory results for post-traumatic stiff elbow, with arthroscopy potentially producing superior results in most cases when performed by experienced surgeons with proper indications [15].
  • Operative management of pediatric elbow contractures is effective [18].

Clinical Presentation

  • Elbow stiffness is a challenging problem with no ideal management solution [8].
  • Elbow contracture is challenging to treat, making prevention of paramount importance [14].
  • Elbow stiffness can be caused by arthritis and heterotopic ossification [1].
  • The functional arc of motion serves as a frame of reference rather than an absolute goal for stiff elbow intervention [9].
  • Although both open and arthroscopic techniques may produce satisfactory results, arthroscopy by experienced surgeons may produce results superior to those of open release given proper indications [15].
  • 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 [10].
  • This treatment approach for bony encasement of the ulnar nerve secondary to heterotopic ossification leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes [19].
  • 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 [21].

Investigations

  • Management of the stiff elbow involves evaluation, prevention, and treatment strategies [3].
  • 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 [10].
  • Prevention of elbow contracture is of paramount importance as it is challenging to treat [14].
  • Arthroscopy by experienced surgeons may produce results superior to those of open release given the proper indications [15].
  • Treatment for bony encasement of the ulnar nerve secondary to heterotopic ossification leads to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes [19].
  • Delayed-onset anterior interosseous nerve palsy can develop one week after open elbow contracture release, likely due to a stretch injury [21].
  • Excision and reconstruction of the ligament with heterotopic ossification can be a viable and reliable solution for elbow joint stiffness, particularly when wide heterotopic ossification involves collateral ligaments [34].

Treatment

  • State-of-the-art guidance exists on the management regarding prevention, evaluation, and treatment of elbow stiffness [3].
  • Additional peripheral nerve block combined with a postoperative nerve block catheter in arthroscopic arthrolysis in cases of elbow stiffness may enhance postoperative outcomes by achieving better functional range of motion, perhaps through reduced postoperative pain [30].

Complications

  • Arthritis and heterotopic ossification are complications associated with elbow stiffness [1].
  • Surgical release for failed nonsurgical treatment of stiff elbow can yield sustained improvement of range of motion and patient quality of life [5].
  • Current treatment options for post-traumatic elbow stiffness have varying rates of complications [11].
  • 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 [13].

Recovery

  • Surgical release can yield sustained improvement of range of motion and patient quality of life in the setting of failed nonsurgical treatment of the stiff elbow [5].
  • Treatment approaches for bony encasement of the ulnar nerve secondary to heterotopic ossification lead to superior range of motion, improved or resolved ulnar neuropathy, and good to excellent long-term functional outcomes [19].
  • Patients who underwent early excision of heterotopic ossification had better restoration of elbow range of motion compared to delayed excision, with no significant differences in recurrence rates between the two groups [35].

Key Evidence

  • [L5] Treatment choices must consider non-surgical management and various surgical options including arthroscopic or open capsular release, arthroplasty, and elbow replacement. [1] (10.1016/j.jisako.2023.10.009)
  • [L4] Arthroscopic elbow contracture release can improve function and range of motion; however, outcomes may vary based on preoperative patient characteristics. [2] (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. [3] (10.1530/eor-23-0039)
  • [L1] Patients with stiff elbows who underwent arthroscopic arthrolysis achieved satisfactory clinical outcomes very early postoperatively. [4] (10.1016/j.jse.2024.06.009)
  • [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. [5] (10.5435/jaaos-d-14-00051)
  • [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. [6] (10.5435/00124635-201105000-00004)
  • [L5] This multinational initiative provides the first comprehensive clinical practice guideline for open arthrolysis in adult posttraumatic elbow stiffness. [7] (10.1016/j.jse.2025.07.015)
  • [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. [8] (10.1016/j.jhsa.2013.06.007)
  • [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. [9] (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. [10] (10.1016/j.jse.2024.11.019)
  • [L5] Current treatment options for post-traumatic elbow stiffness range from conservative to surgical, with varying rates of success, invasiveness, and complications. [11] (10.1177/1758573218793903)
  • [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. [12] (10.1016/j.jhsg.2023.07.002)
  • [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. [13] (10.1186/s12891-024-08167-6)
  • [L5] Elbow contracture is challenging to treat, and therefore prevention is of paramount importance. [14] (10.1016/j.jhsa.2009.02.020)
  • [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. [15] (10.1016/j.jse.2010.11.029)
  • [L5] Treatment of the stiff elbow requires a thorough understanding of normal anatomy and etiological factors to develop effective strategies. [16] (10.1016/j.jisako.2023.10.006)
  • [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. [17] (10.1186/s13018-025-06288-9)
  • [L1] Operative management of pediatric elbow contractures is effective. [18] (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. [19] (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. [21] (10.5397/cise.2022.00899)
  • [L5] The procedure is technically difficult and should be performed by experienced surgeons who are familiar with the neurovascular and musculoligamentous elbow anatomy. [22] (10.1016/j.jisako.2024.02.003)
  • [L3] Orthogonal plate configuration, olecranon osteotomy, and longer operative time were associated with increased odds of dysfunctional elbow stiffness. [24] (10.1016/j.jse.2024.06.010)
  • [L4] Progression of elbow flexion contracture appears to level off after the age of 10 to 12 years, likely ending at skeletal maturity. [29] (10.1177/17531934231178121)
  • [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. [30] (10.1016/j.jseint.2024.10.009)
  • [L4] Excision and reconstruction of the ligament with heterotopic ossification can be a viable and reliable solution for elbow joint stiffness, particularly when wide HO involves collateral ligaments. [34] (10.1016/j.jseint.2025.101418)
  • [L4] Patients who underwent early excision had better restoration of elbow ROM compared to delayed excision, with no significant differences in recurrence rates between the two groups. [35] (10.3390/life13122358)

References

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

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

[3] Management of the stiff elbow: a literature review. EFORT Open Reviews. 2023. DOI: 10.1530/eor-23-0039

[4] 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

[5] Open Surgical Release for Contractures of the Elbow. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00051

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

[7] Clinical guideline on the open arthrolysis for post-traumatic elbow stiffness in adult patients. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.07.015

[8] Prevention and Treatment of Elbow Stiffness: A 5-Year Update. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.06.007

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

[10] 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

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

[12] Outcomes of Therapy and Ulnar Nerve Transposition for Elbow Stiffness After Pediatric Medial Epicondyle Fractures. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.07.002

[13] 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

[14] Prevention and Treatment of Elbow Stiffness. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.02.020

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

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

[17] 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

[18] 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

[19] 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

[21] 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

[22] Endoscopic anterior capsulectomy for severe elbow contractures. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2024.02.003

[24] Risk factors for dysfunctional elbow stiffness following operative fixation of distal humerus fractures. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.06.010

[29] Hems T. Natural history of elbow flexion and forearm rotation contractures in obstetric brachial plexus injury. J Hand Surg Eur. 2022, 47: 1121–7. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231178121

[30] 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

[34] Total resection and reconstruction of collateral ligaments in severe elbow stiffness induced by heterotopic ossification: a novel approach and review of the literature. JSES International. 2026. DOI: 10.1016/j.jseint.2025.101418

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

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a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.