Stiffness in your elbow – sometimes called a contracture – means that you have lost some of the motion in the joint. This loss of ability to fully bend or straighten your arm could have a number of different causes. If you injure your elbow you may develop tightness in the soft tissues (muscles, tendonsand ligaments).. This can also happen after surgery when scar tissue forms. A fracture that heals in the wrong way can also hinder movement.
If you have arthritis in your elbow, you may develop bony spurs which can prevent the joint from full, pain free, movement. Arthritis also causes cartilage in the joint to deteriorate and small pieces can sometimes break off and become wedged between the moving parts of the joint. This can cause the elbow to lock in a fixed position. If this happens, the problem will normally resolve by itself but sometimes the loose fragment needs to be removed.
Unfortunately, the elbow is one of the joints in the body that is most prone to becoming stiff, particularly after injury. How much stiffness you can tolerate depends on your job, hobbies and normal everyday activities, so you may need to seek treatment.
Causes of elbow stiffness
Orthopaedic surgeons classify elbow stiffness as having three types of cause:
- Extrinsic causes are those that come from outside the joint, usually tightness of the ligaments, tendons and muscles crossing the joint. The most common cause of extrinsic stiffness is some type of trauma, such as a fracture or dislocation.
- Intrinsic causes are those that come from inside the joint, such as bone spurs and loose pieces of cartilage that restrict movement of the elbow. Arthritis is a degenerative condition, which means it worsens over time. Cartilage, which is the protective layer that covers bones inside the joint begins to wear away, causing bone to rub against bone. You may develop inflammation, pain and stiffness and bony spurs can grow within the joint. Osteoarthritis – or wear and tear arthritis – is common in people with manual jobs, however the elbow is often affected by other types of arthritis such as rheumatoid, psoriatic and gout.
- Mixed causes are a combination of extrinsic and intrinsic.
Preventing elbow stiffness
Elbow stiffness can be difficult to treat so orthopaedic surgeons generally advise people to try and prevent it if they can by starting to move their elbow as soon as possible after injury or surgery, but without causing themselves pain.
A physiotherapist will be able to recommend some appropriate exercises.
Surgeons classify fractures as either stable or unstable. A stable fracture means it is safe to exercise your elbow immediately after injury. If the fracture is unstable then an operation may be recommend to stabilise the fracture so that you can move the joint sooner and prevent severe stiffness setting in.
Diagnosing elbow stiffness
Your doctor will examine you to assess the level of stiffness and pain. You may be referred for an X-ray, which can show any pieces of loose bone in your joint or bony spurs that have developed.
Sometimes a CT or MRI scan may be needed to confirm or rule out a diagnosis. MRI scans give the doctor a reasonably detailed picture of all of the structures of your elbow so they can see exactly what is going on inside the joint. However, if it becomes clear that the problem is due to bone spurs or loose bone, then a CT scan may be required to assess the exact position more accurately.
An accurate diagnosis is always the first step to better understanding the cause of elbow stiffness.
Treatment of elbow stiffness
Non-surgical treatments are normally recommended in the first instance. A physiotherapist will be able to recommend exercises to help relieve elbow stiffness and increase the range of movement in your joint. You can also take painkillers and anti-inflammatory medication to help push the range of motion within tolerable limits.
If you have had elbow surgery or a fracture, early mobilisation will help prevent tissues in the joint from becoming overly tight. Arthritis may be treated using a steroid injection for short-term relief of symptoms and this may help the range of motion in the elbow.
However, if conservative measures fail to relieve elbow stiffness you may be offered surgery such as a procedure to relieve tension in tight muscles and ligaments. This is often followed by a short period of wearing a splint at night to stop the contracture returning. Bone spurs from osteoarthritis can be also be removed. If pieces of cartilage are trapped within the joint, you may be offered arthroscopic (or keyhole) surgery to remove them. If you have rheumatoid or psoriatic arthritis that is having a significant impact on your day-to-day life you may be able to have elbow replacement surgery, but this is not generally recommended for other types of arthritis.
If you are experiencing elbow stiffness, seek help from an orthopaedic specialist who will be able to diagnose the cause. You can then discuss the most appropriate treatment plan.