Post Traumatic Stiffness
POST TRAUMATIC STIFFNESS
What is it?
This is a condition of stiffness of the elbow joint. It can follow trauma (injury) to the elbow joint which doesnt have to be significant. Surprisingly major injuries may not necessarily be associated with post traumatic stiffness. Simply put the severity of the injury doesnt necessarily dictate the degree of stiffness of the elbow although overall the more significant the injury the more likely there is to be stiffness. The stiffness is as a result of a combination of factors being present, soft tissue contracture, fracture position and extra bone formation.
History and examination: the history includes the injury and either immediate or slowly progressive loss of movement of the elbow joint. This loss of movement can be bending and straightening (flexion and extension) turning the palm up and turning the palm down (supination and pronation) in varying degrees.
Radiographs can reveal the position and presence of the bone and abnormal bone. A CT scan gives greater detail of the bone and can help with preoperative planning. A magnetic resonance scan can aid in showing the thickening of the soft tissues involved in the contracture.
The choice is to accept the range and function or proceed to an operation.
The operation can be done as a general anaesthetic or alternatively with a local anaesthetic. This is an injection in the neck which numbs the shoulder and arm negating the problems associated with anaesthetic gasses and allows patients to stay awake and watch their operation. If preferred patients can listen to music rather than watch or have a supplementary relaxing injection. It is important to note however that patients having an operation with Martin Holt can have a local or general anaesthetic - its your choice.
The procedure releases the soft tissues and removes the extra bone where present. Often by two incisions either side of the elbow joint. This is not a simple procedure and all patients with this diagnosis need to be aware that there is a great deal of effort required by them after the operation to optimise the result in terms of movement and function.
Dressings placed over the surgical incision are retained for 7-10 days. Absorbable sutures are used but these do not require removal as they dissolve over the course of time. The operation is followed by intensive physiotherapy both formally with the therapist and also diligently following the instructions for the exercises as part of a home unsupervised physiotherapy program.
Time off work
The time you have off work doing the physiotherapy can vary and is dependent on several factors but importantly on the pathology, rate of healing and your occupation.