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僵硬肘关节松解术（关节松解术）

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Updated Sep 2026
Illustration: 僵硬肘关节松解术（关节松解术）

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

为何建议进行此手术

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生会从适合您病情的微创方案入手。患者通常由其全科医生（GP）转诊至我们的诊所；如果理疗师建议您就诊，您仍需获得全科医生的转诊，方可符合 Medicare 报销资格。在您的就诊过程中，我们会采集病史，检查您的肘部，并在必要时安排影像学检查。由于肘关节僵硬通常会随时间和使用而改善，我们通常首先尝试非手术治疗。这可能包括为期 6 至 12 周的物理治疗、支具固定或注射治疗。当上述疗程未能带来足够的改善时，我们会考虑手术。

肘关节僵硬松解术，也称为关节松解术，是一种旨在松解肘部周围紧绷、瘢痕化组织的手术，以便关节恢复活动。当非手术治疗后僵硬仍对您造成限制时，我们会建议进行此手术。当关节面仍保持光滑且形态正常时，该手术效果最佳。其目标是获得持久的活动度改善并减轻疼痛，从而使日常任务变得更加容易。

术前

一旦确定手术计划，有几件实际事务需要安排。您将被告知何时停止进食和饮水：这需要在手术前七小时进行。我们要求七小时而非六小时，以便如果手术室排班提前，我们可以将您的手术提前。您的外科医生会告诉您哪些常用药物需要停用以及何时停用，您应携带完整的药物清单。安排有人在术后开车送您回家。当天请穿着宽松、舒适的衣物。为规划手术，始终会拍摄X光片；如果僵硬涉及骨骼，可能会使用CT扫描。如果您有其他健康状况，可能需要进行血液检查或与麻醉师进行会诊。

手术当日

您抵达医院的手术入院单元，在此办理入院手续并进行术前准备。您将在该处见到麻醉师。本手术在全身麻醉下进行。有时会追加区域神经阻滞以缓解术后疼痛；麻醉师将在手术当日就此与您沟通。随后，您将被带入手术室进行手术。

您将在复苏区苏醒，护士会在此监测您的状况，直至麻醉作用消退。待您的生命体征稳定后，将根据手术类型及您的恢复情况，决定您是转入病房还是直接回家。

手术内容

松解僵硬肘关节的方法不止一种，您的外科医生会选择适合您肘关节的手术入路。部分松解手术通过关节镜（微创）手术完成，使用几个小切口和一根细长的内窥镜。其他手术则通过一个或两个开放切口完成，切口有时长约3至5厘米，位于肘关节内侧或外侧。对于极度僵硬的肘关节，可能会在肘关节后方做一个切口，以便同时到达两侧。

进入关节后，您的外科医生会松解紧绷的关节囊，即包裹关节的组织袖套。阻碍活动的骨刺会被切除，关节内漂浮的任何松动的骨或软骨碎片也会被取出。如果肘关节内侧的神经被瘢痕组织挤压，可能会将其从该组织隧道中松解出来，或将其移位到一个不会被牵拉的新位置。如果关节面本身磨损严重，还存在其他选择，例如用软组织覆盖骨骼，或用金属和塑料部件替换关节面。有时会在肘关节上安装一个铰接支架，以在愈合期间将关节保持在良好位置。

手术结束时，切口用缝线缝合并覆盖敷料。您将保持该敷料约10天，具体说明见恢复章节。

术后

您将在恢复区醒来，随后转入病房。护士会检查您的肘部、手部以及您的整体感受。止痛药会按需给予；如果您的肘部感到不适，请告知护士。您的肘部将用软敷料包扎，您回家时可能会佩戴吊带以缓解不适。您很快就可以下床活动，护士会在第一次下床时协助您。在肘部恢复期间，您的手、手腕和肩部可以自由活动。回家后，前24小时应有人陪伴您。医疗团队会告知您是当天回家还是在医院过夜。我们会保留敷料约10天；除非我们告知您，否则请勿在此之前拆除。我们会在复诊时为您更换或拆除敷料。

恢复

您的肘部在最初几天和几周内会感到疼痛和肿胀。这是松解术后的正常现象。休息、抬高患肢并按医嘱服用止痛药可以缓解不适。肿胀会逐渐消退，随着肿胀的消退，肘部通常会感觉不那么紧绷。

您回家时手臂会佩戴吊带以提供舒适感。一旦吊带不再有帮助，您可以停止使用。您的手、手腕和肩部从一开始就应保持自由活动。术后的手部治疗由 Extend Rehabilitation 的 Ruby Doolan 负责。Ruby 将指导您的锻炼并为您制作所需的夹板。锻炼是恢复的主要工作，按照指示进行锻炼比其他任何事情都重要。您需要保留敷料约 10 天，我们在复诊时会为您更换或拆除敷料。

日常任务将分阶段恢复。起初，您在烹饪、穿衣和搬运物品时需要帮助。随着活动能力的恢复和肿胀的消退，您将能更好地使用手术侧手臂。一旦您的外科医生允许您驾驶，您即可返回道路；我们关于 上肢手术后驾驶 的指南解释了适用的规则，包括手臂佩戴吊带时不得驾驶以及停用强效止痛药。

恢复情况因人而异。您的时间表可能有所不同，您的外科医生和治疗师将在整个过程中为您提供指导。

可能出现的并发症

大多数患者恢复良好，但偶尔也会出现问题。您的外科医生和医疗团队会密切监测您的状况，以便尽早发现任何问题。

肘关节僵硬的时间越长，松解术后出现问题的可能性就越大。如果您的肘关节已经僵硬了很长时间，外科医生会在您做出决定之前与您详细讨论这一点。

一些患者在术后会注意到小指和无名指出现新的麻木、刺痛或无力感。这是由于肘关节内侧的神经引起的。并非总能预测哪些人会出现这种情况。如果您注意到这些感觉，请在下次复诊时提及，或者如果这些感觉突然出现，请致电诊所。

以前受过伤的肘关节在术后发生深部感染的风险较高。请留意伤口周围出现的扩散性发红、发热、肿胀加剧，或简单的止痛药无法缓解的深部搏动性疼痛。您可能会感到发烧或整体不适。如果您发现这些迹象，请立即致电诊所，或在非工作时间前往急诊科。

如果您的手术涉及在肘部安装铰接式外固定架，还有几件事需要了解。外固定架会增加手术中的失血量、手术室停留时间和住院时间。它还存在关节变得松动或不稳定的小概率风险。您的外科医生会向您解释这对您的住院和恢复意味着什么。

如果您以前在这个肘部做过手术，深部感染的风险会再次升高。当手术本身更复杂时，情况也是如此。您的外科医生会事先与您权衡所有这些因素。

长期的肘部损伤也会改变关节的功能。瘢痕皮肤、错位愈合的骨骼、受损的软骨、多余的骨赘、松弛或紧绷的韧带、受压的神经以及瘢痕化的肌肉都可能改变肘部的活动方式。您的外科医生在制定手术计划时会寻找这些情况。

如果您想了解具体数据，本页上的并发症表格列出了典型的发病率。

何时联系我们

如果您注意到发热、伤口周围红肿扩散、伤口有分泌物，或疼痛持续加重，请致电我们。如果您出现突发剧烈疼痛、小腿肿胀或疼痛，或呼吸困难，请立即前往急诊。如果您的手或手指出现麻木或苍白，或无法活动手臂，请立即致电我们。如果小指和无名指突然出现刺痛或麻木，请致电诊所，不要等到下次复查。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您自身治疗决策所需的范围。深入阅读肘关节僵硬松解术是值得的，因为证据指向一个不寻常的结论：大多数患者询问的关键选择——微创（关节镜）或开放手术——似乎不如手术范围的大小重要，而该手术真正的对手正是最初导致僵硬的那个病理过程。

开放手术或关节镜手术并非关键问题

一项针对 4,311 例创伤后肘关节僵硬患者的系统评价和荟萃分析比较了开放松解术与关节镜松解术，发现总体疗效 相当 [1]。其结论是，与手术技术本身相比，外科医生的专业水平以及患者的具体病情是更为重要的考量因素 [1]。

对于一项系统评价而言，这是一个异常直白的陈述，值得按字面意思理解。这是一项技术要求极高的手术，操作部位邻近三条主要神经，且关节的活动度已因待治疗的挛缩而受限。对入路方式的熟悉程度比入路方式本身发挥的作用更大。

手术更少，问题更少

一项针对 798 名患者的早期系统综述得出了一个经得起时间检验的结论：并发症的数量似乎随着手术 范围 的扩大而增加，由此得出的建议是尽可能以微创方式进行治疗 [2]。作者对该建议的评级较为保守，因为现有文献不足以得出确凿的统计学结论，但其趋势是一致的。

这正是手术的核心矛盾所在。更彻底的松解术能在手术台上换取更多的活动度，但代价是更多的软组织创伤、更多的关节内出血以及更多的炎症刺激，而这些正是僵硬复发的原材料。

异位骨化是需要预防的问题

异位骨化是指本应保持柔韧的软组织中形成骨组织，这是松解术后肘关节再次僵硬化的机制。使用抗炎药物进行预防是标准做法，尽管其证据基础较实践更为薄弱。

一项针对622例肘部创伤手术患者的荟萃分析比较了COX-2选择性抗炎药与非选择性抗炎药，发现两者均能有效降低异位骨化的风险，而各项头对头比较显示两者之间无统计学显著差异，且证据的总体效力较低 [3]。因此：预防似乎是有价值的，药物选择的影响并不明确，且确定性有限。

背景信息有助于设定预期。在肘关节全置换术后，异位骨化是一种不常见的并发症，且在其发生时，大多数患者无症状且无需为此接受手术，以至于文献不支持在该手术后进行常规预防 [4]。肘部手术中的风险并非均匀分布；它主要集中在创伤和广泛松解术中。

一项干预措施的效果并非如你所料

氨甲环酸可减少许多骨科手术中的出血，而减少新鲜松解肘关节内的出血听起来似乎应能减少僵硬。一项针对660例患者的荟萃分析发现，氨甲环酸确实可能减少开放肘关节松解术中的出血量，但它并未影响最终的活动度或疼痛评分 [5]。

这是一个机制看似合理却未能转化为任何人关心的结局的清晰范例，也提醒我们“出血减少”是一个替代指标，而非最终结果。

真正决定您预后的因素

现有文献中没有任何证据表明存在技术上的捷径。一致的信息是：手术范围不应超过必要程度；采取预防异位骨化的措施是值得的；且在手术中获得的关节活动度仅能通过术后的康复训练得以维持。肘关节异常容易僵硬；释放术后的数月康复与释放术本身同等重要。

参考文献

[1] Khorram R, Ghayyad K, Vafadar R, Borazjani R, Nezameslami A, Huffman GR, et al. 创伤后肘关节僵硬的手术治疗：系统综述与荟萃分析. J Shoulder Elbow Surg. 2026;35(1):387-407. https://doi.org/10.1016/j.jse.2025.05.004

[2] Kodde IF, van Rijn J, van den Bekerom MP, Eygendaal D. 创伤后肘关节僵硬的手术治疗：系统综述. J Shoulder Elbow Surg. 2013;22(4):574-80. https://doi.org/10.1016/j.jse.2012.11.010

[3] Ahmad A, Khorram R, Ghayyad K, Amin V, Kachooei AR, Huffman GR, et al. 肘关节异位骨化的术后非甾体抗炎药预防：比较COX-2选择性与非选择性抑制剂的系统综述与荟萃分析. JSES Rev Rep Tech. 2026;6(2):100628. https://doi.org/10.1016/j.xrrt.2025.100628

[4] Liu EY, Hildebrand A, Horner NS, Athwal GS, Khan M, Alolabi B. 全肘关节置换术后异位骨化：系统综述. J Shoulder Elbow Surg. 2019;28(3):587-95. https://doi.org/10.1016/j.jse.2018.10.003

[5] Nejat MH, Khayami A, Daliri M, Ebrahimzadeh MH, Sadeghi M, Moradi A. 氨甲环酸能否减少开放性肘关节松解术的出血和疼痛？系统综述与荟萃分析. BMC Musculoskelet Disord. 2023;24(1). https://doi.org/10.1186/s12891-023-06835-7

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.

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

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

[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

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

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

[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

[9] 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

[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

[13] 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

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

[15] The Posttraumatic Stiff Elbow: A Review of the Literature. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.09.015

[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

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

[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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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.

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