What is elbow arthrolysis?

Elbow arthrolysis is a surgical procedure that addresses all conditions provoking stiffness and therefore significantly reduced range of motion in the elbow joint. Physiotherapy is an essential precaution to take both before and after elbow arthrolysis to maximize the movement and function of the elbow joint.

One of the common problems is elbow stiffness, which is caused by numerous conditions, such as osteoarthritis and fractures of the elbow joint that occur from injuries caused by previous surgeries and treatments.

How are techniques performed to cure elbow arthrolysis?

Various methods can be used to enhance the range of motion, depending on the nature of your elbow stiffness and anatomy.

The column procedure (a laterally based incision with full release of your anterior capsule, bony spur resection, and loose body removal) is a powerful technique that achieves, on average, 30 degrees of arc improvement. If your radial head is arthritic, this can also be removed through the same incision.

If you lose flexion, you may need medial access to lyses a tightened part of your ligament on that side, and any impinging anterior structure needs to be resected.

There are some cases where arthroscopic release will give the functional gain needed. However, it is not possible in all cases (dense scarring post-trauma).

What to expect before elbow arthrolysis surgery?

Physiotherapy before your elbow arthrolysis surgery is advised, preparing your elbow better for the surgery and helping towards a speedy and uncomplicated recovery afterward. Before your surgery, you will work on maintaining as much range of movement in your elbow as possible, along with looking to strengthen all of the muscles surrounding the elbow joint, including the biceps and the triceps. The stronger the elbow is before surgery, the more effective your elbow arthrolysis surgery will be.

When do you need elbow arthrolysis surgery?

For an arthrolysis to be worthwhile in terms of risks and efforts in the surgery, the elbow should be stiff enough to become a nuisance for you. In most cases, this means that you should have lost at least half your normal amount of forearm rotation and/or at least 50° of your normal range of flexion and extension.

You can find out what is normal for you by looking at what you can do with the other elbow. Those limits apply because, after this kind of surgery, the joint will stiffen again to some degree. These cuts back on how much in the way of improvement in your movement you get to keep after the operation.

Other treatments such as physiotherapy, splints and exercises should be tried before surgery would be considered. Most patients find they can tolerate a minimal loss of range of motion in their elbow without too much problem. A very painful stiff elbow is unlikely to be well treated by arthrolysis alone because the latter may not help the pain. Other treatments will have to be considered in this case.

What does this surgery do?

Elbow arthrolysis surgery involves the creation of several small incisions at the lateral aspect and the posterior part of the elbow joint. Through these incisions, the surgeon observes the anterior part of the elbow and debrides the scar tissues inside the elbow. By releasing the restricted joint capsule and contracted tissues, more movement in the joint is allowed. The release on the outer side of the joint starts along with the removal of adhesions. Then, the release of the restricted joint capsule and the contracted tissues on the inner side of the joint is done. The medial ligament on the inner side of the elbow is then allowed to release a further range of movement within the joint. Then, one handles bony abnormalities. The wounds are then closed with tiny butterfly stitches.

What happens next?

It is extremely important to physiotherapy after your elbow arthrolysis in order to get the best possible result from your operation. We will give you a full course of physiotherapy that will ensure you do not experience any further problems in your elbow, and we can get you back to nearly full function within your elbow joint. To safely and most efficiently return to normal or high-level functional activity, you will require adequate strength, flexibility, and endurance in your elbow. After elbow arthrolysis, your rehabilitation may take up to 3 months before achieving a successful and full recovery. The most important thing you should not do is return too soon to higher-level activities post-surgery because this will increase your risk of repeat problems and possible injury.

What are the outcomes of this procedure?

Studies describe that around 80% of patients are satisfied following this procedure, but less than 1% of patients regain full-range elbow motion. The range of motion at 1 year after the operation appears to be preserved for several years.

How long does it take to recover from elbow arthrolysis?

You will be advised to wear the sling provided for up to 48 hours following your elbow arthrolysis, and you may wish to wear short-term clothing while you are out and about for necessary support and protection. The initial goals of your physiotherapy treatment are to start controlling any discomfort and swelling you may be experiencing and to try to increase your range of movement as soon as possible after your surgery. Generally, it's really important to start on an early movement in your elbow joint, especially at the early stages of your recovery, and a good prognostic factor in terms of your rehabilitation and elbow function long-term. Your physiotherapy will include the following:

• Cryotherapy (ice)
• Pain modalities
• Shoulder, wrist, and hand active range of movement exercises
• Elbow passive range of movement exercises
• Mobility exercises for the upper limb, i.e., shoulder shrugs
• Stretching exercises for muscles of the upper limbs

1-4 weeks

The first month of your rehabilitation process is still going to be about pain control and managing the swelling you are currently experiencing, as well as maximizing as much passive-assisted and active range of movement as possible within your elbow joint. You will begin to concentrate your exercises on improving the strength of the muscles surrounding your elbow joint to assist in your recovery more. Your physiotherapy will involve the following: 

• Cryotherapy
• Use of a sling when out and about for protection-not required long-term
• Passive range of movement exercises at the elbow and wrist-bending, straightening, twisting.
• Gradually progressing to an active range of movement exercises
• Isometric (hold) strengthening exercises for the muscles around your elbow joint (pronator teres, supinator, brachioradialis, biceps, triceps)
• Creeping of palms with putty/sponge
• Mobilization exercises of upper limbs (shrugs of shoulders, etc.)
• Dynamic stretching to improve mobility
• Strengthening muscles of the wrist, hand, and shoulder
• Opposite arm activities

4-8 weeks

Following four weeks of effective rehabilitation, your physiotherapy program will aim to advance activities to continue improving strength, range of movement, and flexibility observed in previous weeks. As treatment continues, goals will incorporate working towards improving your cardiovascular fitness and muscle endurance for optimal functioning in your affected and non-affected upper limb. Your physiotherapy will be comprised of the following:

• Continuation of modalities to control pain and swelling (if applicable)
• Exercises with active movement range (bending, straightening, and twisting elbow joint)
• Exercises for the active strengthening of muscles in and around the elbow
• Strengthening exercises, stretching, and moving range exercises for the wrist and hand
• Strengthening, stretching, and movement range exercises for the shoulder
• Activities to be carried out with the opposite arm
• Arm cycle
• Hydrotherapy

8-12 weeks

In your third month of rehabilitation following elbow arthrolysis, your physiotherapy would be to continue improving the exercises from the past weeks. Some of your physiotherapy would comprise the following;

• Continuation of strengthening, stretching, and range of movement exercises for muscles in the elbow
• Continuation of strengthening, stretching, and range of movement exercises for the wrist, hand, and shoulder of the affected arm and also equivalent exercises for the opposite arm
• Arm cycle (resistance as tolerated)
• Hydrotherapy

Three months after your elbow arthrolysis surgery and once you have completed physiotherapy; you will have significantly improved the strength of the muscles in and around your affected upper limb, range of movement, flexibility as well as cardiovascular fitness. You should by now be feeling no pain during movement in your elbow, and your physiotherapy will continue to focus on preventing further problems involving your elbow joint. Your physiotherapy will continue to focus on improving your cardiovascular fitness and muscle endurance while also gearing towards more job, sport, or hobby-specific activities.

Full recovery after elbow arthrolysis can take up to 3 months. The success and rate of your recovery will also depend on how committed you are and compliant you remain in undertaking your complete physiotherapy programme and the state of your elbow before proceeding with your elbow arthrolysis surgery.

When to see a doctor?

See your surgery at any stage if:

• Your fingers become considerably more swollen, stiffer, or more than you expected.
• If you find leakage or wetness, or you can smell something bad and you suspect it is coming from your wound under the dressing.
• If you need to report after normal working hours, go to the Accident and Emergency Department of your local hospital.

Why Tender Palm Super-Speciality Hospital for Elbow arthrolysis?

Tender Palm Hospital, owned by doctors, is renowned for attracting the most skilled professionals in the country. With the finest Orthopedic surgeons, specialized in Elbow arthrolysis. Tender Palm stands out as the premier orthopedic hospital in Lucknow, India. Boasting cutting-edge infrastructure and advanced technology, Tender Palm ensures top-notch medical care for its patients.

To seek an expert consultation for any orthopedic condition.

Call us at +91-9076972161
Email at care@tenderpalm.com

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