Elbow contracture is a persistent restriction of movement in the joint. There may be difficulties in bending, extending, turning the forearm inwards or outwards. Usually contractures are combined, that is, movements are limited in several directions at once. In most cases, contractures are accompanied by pain and joint deformity. The diagnosis is confirmed on the basis of an examination, the results of measuring the volume of movements and radiography data. If necessary, MRI, CT and other studies are prescribed. Treatment is more often conservative, in severe cases surgical operations are performed.
M24.5 Joint contracture
Elbow contracture is a restriction of movements in the joint caused by congenital underdevelopment of bone, cartilage or muscle tissue or shortening of muscles, wrinkling of fascia, violation of the shape of articular surfaces or scarring of the joint due to trauma (intraarticular fracture, repeated dislocations), inflammation (elbow bursitis, epicondylitis, arthritis), dystrophic process, prolonged immobilization, etc. D. Disability with restricted movements in the elbow joint occurs less frequently than with contractures of the joints of the lower extremities (knee, hip). Traumatologists-orthopedists are engaged in the treatment of this pathology.
The most common cause of the development of elbow contracture is the lack of reposition or insufficiently accurate comparison of fragments in periarticular fractures and fractures. The restriction of movement in such cases is due to the presence of a mechanical obstacle. In addition, after injury, movement may be limited due to hemorrhage in the joint (hemarthrosis), ruptures of the articular bag, followed by the formation of scar adhesions and inflammation of the periarticular soft tissues. With fractures of the shoulder and forearm (including those that occur far enough from the elbow joint), immobilization contractures may develop.
Contractures after purulent arthritis, extensive burns, lacerated and lacerated bruised wounds are less common. In some cases, movement restriction occurs due to injuries and diseases of the brain or peripheral nerves. In addition, elbow contractures are observed with such congenital malformations as myopia, radioulnar synostosis and congenital dislocation of the beam head. Movement restrictions in arthrosis of the elbow joint, as a rule, are not sharply expressed, do not in themselves affect the ability to work and therefore do not have much clinical significance.
The elbow joint is a complex joint. Its formation involves the articular surfaces of three bones: the humerus, ulna and radius. The humerus is connected to the block–shaped notch of the ulna and the head of the radius, and the head of the radius is connected to the radial notch of the ulna. Thus, the volume of movements is provided by three joints: beam-elbow, shoulder-beam and shoulder-elbow, united by a common capsule and joint cavity.
In the elbow joint, extension, flexion, supination (turning the forearm with the palm side in front) and pronation (turning the forearm with the back side in front) are possible. Normally, extension is carried out to an angle of 180 degrees, flexion – to an angle of 40 degrees. People with large muscle mass sometimes have a slight restriction of extension. The amplitude of movements during supination and pronation can range from 140 degrees in untrained people to 180 degrees or more in athletes.
Taking into account the origin, all joint contractures in traumatology and orthopedics are divided into arthrogenic, myogenic, dermatogenic, desmogenic (with connective tissue scars), immobilization and neurogenic (with pathology of the central and peripheral nervous system). Taking into account the type of restriction of movements, flexion (limited extension), extensor (limited flexion), pronation and supination contractures are distinguished.
The most common are flexion contractures in the area of the elbow joint. Taking into account the severity of the restriction of movements, 4 degrees of such contractures are distinguished:
- 1 – extension of at least 170 degrees is possible.
- 2 – extension up to 130-170 degrees is possible.
- 3 – extension up to 90-130 degrees is possible.
- 4 – extension is less than 90 degrees.
Taking into account the peculiarities of pathological processes , there are three stages of post – traumatic contractures:
- Stage 1 – up to 1 month after the injury. Movement restriction is caused by pain, prolonged fixation and/or psychological factors. With timely therapy, pathology in most cases is easily curable.
- Stage 2 – more than a month after the injury. The restriction of movement is caused by the adhesive process and the formation of scar tissue.
- Stage 3 – a few months after the injury. Scar tissue degenerates into fibrous tissue, the scar is tightened.
Clinical manifestations are determined by the severity of elbow contracture, the nature and severity of the underlying pathology. Patients complain about the inconvenience or inability to perform actions that require flexion, extension, external or internal rotation of the limb. The examination often reveals deformities of the joint area. The volume of passive and active movements is limited. The severity of contracture is determined by the degree of reduction in the volume of movements.
To clarify the diagnosis, in all cases, an examination is carried out, the volume of movements is measured and an elbow X-ray is performed. The plan for further examination depends on the cause of the development and features of the pathology. If necessary, an elbow MRI is prescribed to assess the condition of soft tissues. If a violation of the nervous system is suspected, the patient is referred for consultation to a neurologist or neurosurgeon.
Treatment of this pathology is more often conservative, especially with fresh contractures. Staged plaster dressings are used, allowing to correct the position of the joint without surgery. They use mechanotherapy, physical therapy, thermal procedures, massage and various methods of stretching. With sluggish paralysis, galvanization is prescribed at the initial stage, and then proceed to the rest of the procedures. Active development is often accompanied by pain, swelling and the appearance of signs of inflammation in the joint, so patients are prescribed NSAIDs. With severe pain syndrome, joint blockades are performed.
Indications for surgical treatment are the presence of improperly fused bone fragments that interfere with movements in the joint, rough massive skin and connective tissue scars in the joint area, as well as the ineffectiveness of conservative therapy with pronounced combined contractures (restriction of flexion and / or extension in combination with restriction of pronation and supination). The surgical technique is chosen taking into account the nature of the pathology. Bone fragments interfering with movements are removed. The scars are excised, the tissue defect is replaced with an auto- or allograft. In case of significant destruction or scarring, elbow joint replacement is performed.