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 Shoulder/Elbow Test 5: The Shoulder and Elbow
CME 3: July, August, September 2004
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The Journal of Bone and Joint Surgery (American) 86:1955-1960 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Anterior Release of the Elbow for Extension Loss

Julian M. Aldridge, III, MD1, Thomas A. Atkins, MD1, Eunice E. Gunneson, PA-C1 and James R. Urbaniak, MD1

1 Division of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710. E-mail address for J.M. Aldridge III: aldri004{at}mc.duke.edu

Investigation performed at the Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: There are many causes of elbow contracture. When nonoperative techniques fail to increase the arc of motion of the elbow, surgical intervention may be indicated. The purpose of this study was to report the outcomes of surgical correction, predominantly with an anterior release, of elbow flexion contractures. In addition, we evaluated the efficacy of continuous passive motion in the immediate postoperative period.

Methods: We retrospectively reviewed the outcomes of 106 consecutive patients who had undergone anterior elbow release for the treatment of a flexion contracture between July 1975 and June 2001. Twenty-nine patients were excluded because they had been followed for less than twelve months, leaving a study group of seventy-seven patients. Postoperatively, fifty-four of the seventy-seven patients were treated with continuous passive motion and the other twenty-three patients were treated with extension splinting. The average duration of follow-up was thirty-three months. The average patient age was thirty-four years. The results were evaluated on the basis of both preoperative and postoperative radiographs as well as clinical measurements of elbow motion, all performed by the same examiner using the same large (47-cm-long) goniometer.

Results: The mean preoperative extension in the seventy-seven patients was 52°, which decreased to 20° postoperatively. The mean flexion increased from 111° preoperatively to 117° postoperatively, and the mean total arc of motion increased from 59° to 97°. The total arc of motion in the patients treated with continuous passive motion increased 45°, compared with an increase of 26° in those treated with extension splinting. There were eleven complications in ten patients. The majority were traction neuropathies. There were two infections (one superficial and one deep), both of which resolved following treatment.

Conclusions: Release of a pathologically thickened anterior elbow capsule through a predominantly anterior approach to correct diminished elbow extension is a safe and effective technique. Furthermore, compared with splinting in extension alone, the utilization of continuous passive motion during the postoperative period increases the total arc of motion.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.


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