The elbow is a very complex joint. The elbow is one of the very few joints in the body that by design bends and extends as well as rotates. There are numerous reasons an elbow may not move, but the most common reason is due to an injury. Most common is an elbow fracture, usually from falling on the elbow or on an outstretched hand causing stress over the elbow bones causing the bone to break.
When an elbow doesn’t move, the first step is to determine why. The elbow is like the hinge on a door and after a fracture, there could be a piece of bone in the joint blocking full motion of the elbow. Or, like a hinge on a door, the bones may be out of alignment causing the forces on the elbow to change and not allowing full motion. The most common reason is the tightening of soft tissue around the elbow. Just how we get “knots” in our neck and back, after an injury, the soft tissues around the elbow can tighten to protect the injured area.
Fortunately there are various techniques that can be used to regain motion. If there is bone in the joint, your physician can, through a small incision, remove the bone fragments from the elbow joint. If the bones are not aligned correctly, your physician may decide to manipulate the elbow back into alignment and cast the area or surgically realign the bones using plates, screws, and/or wire. If the stiffness is determined to be from soft tissue, your therapist can regain the motion through various stretching techniques.
Many patients benefit from simple stretching which involves the therapist placing their hands on your arm and stretching it straight as well as pushing the elbow into flexion. This stretching causes micro tears in the soft tissue, that when healed, lengthen the soft tissue back to normal length. The most common soft tissue involved in elbow stiffness is the bicep and triceps muscles with their corresponding tendons.
There are times when normal stretching does not regain full motion. At this time, various static progressive and/or dynamic splinting/bracing can be used. The terms static progressive and dynamic refer to how the splint/brace works to regain motion. These splints/braces are worn at home for a specific time, determined by the therapist and the brace representative. The splints/braces make up for the time you are not in therapy. When you factor in therapy, which is usually 2-3 times a week, that’s only 2-3 hours a week of getting the joint stretched. These braces add another 1-4 hours a day of stretching which can dramatically improve motion.
With time and patience, an elbow that is stiff will return to normal motion in most cases. Through the hard work you put in with your home exercise program and the time your therapist puts into stretching you at therapy, you will be back to your everyday activities in no time!
Dave Bower is an Occupational Therapist specializing in upper extremity diagnoses. Read more about Dave.