Chapter 80 - Elbow Stiffness

Question 1

what motion causes more functional loss?

Answer 1

flexion and supination losses causes more disability than extension and pronation losses

Question 2

if an elbow has less than 100 degrees flexion what is contracted?

Answer 2

posterior band of the medial collateral ligament (aka ulnar collateral ligament)

Question 3

mid flexion pain is more indicative of what condition

Answer 3

intrinsic disease - may not improve with contracture release alone

Question 4

what is a contraindication for arthroscopic posterior band mcl release?

Answer 4

subluxation of he ulnar nerve -> risk of iatrogenic injury

Question 5

intrinsic contracture

Answer 5

primary cause of stiffness if related to intra-articular pathology
- common causes:
intraarticular fracture non/mal union
joint incongruity
inflammatory arthropathy
osteochondritis dessicans
post-traumatic arthritis and OA

Question 6

extrinsic contracture

Answer 6

primary cause of stiffness is extraarticular
- HO
- eschar from burns
- myositis ossificans/other mm conditions
- capsular contracture

Question 7

mixed contracture

Answer 7

MOST common

Question 8

outcomes of surgical release of intrinsic vs extrinsic contracture

Answer 8

results are better and more predictable in extrinsic contracture, especially with a congruent joint

less predictable with intrinsic contracture, especially if mid arc pain is present

Question 9

what nerve is most at risk with arthroscopic contracture release?

Answer 9

radial >ulnar>median

Question 10

where should you avoid using suction/shavers in elbow capsular release arthroscopy?

Answer 10

posteromedial gutter

Question 11

indications for an elbow interpostion arthroplasty

Answer 11

INTRINSIC contracture
- young person (20-50)
- maintained overall joint architecture