Manipulation under anesthesia for the postsurgical stiff elbow: a case series and review of literature

Eur J Orthop Surg Traumatol. 2019 Dec;29(8):1679-1685. doi: 10.1007/s00590-019-02492-6. Epub 2019 Jul 6.

Abstract

Introduction: Elbow joint stiffness is a common complication following elbow trauma or surgery. Current practices include first-line treatment with physiotherapy and various types of splints. In cases where early postoperative loss of elbow motion interferes with activities of daily living, manipulation under anesthesia (MUA) is considered a viable treatment option, but there is currently only limited data on the results of this procedure and its complications.

Materials and methods: This retrospective study was comprised of 12 consecutive patients who underwent MUA for the treatment of postsurgical elbow stiffness in one institution between 2010 and 2017. Their pre- and post-manipulation range of motion and their functional scores were assessed.

Results: MUA was performed at a mean of 52 days (range 39-91 days) following the last surgical intervention, and the patients were followed for a mean of 3 years (range 0.75-7 years). The average flexion-extension arc of motion improved by 53.8°, and the average rotation arc improved by 57°. The average Mayo Elbow Performance Score was 73 (range 0-100) at the latest follow-up. Two patients eventually underwent an open elbow contracture release due to poor post-manipulation results. There were no post-MUA complications.

Conclusions: MUA of a postoperative stiff elbow can improve both flexion-extension and rotatory arc of motion in cases of early evolving postoperative stiffness and should be part of the armamentarium for the treatment of this often debilitating condition.

Keywords: Case series; Contracture release; Manipulation under anesthesia; Range of motion; Stiff elbow.

Publication types

  • Review

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Child
  • Conscious Sedation
  • Elbow Joint / physiopathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Manipulation, Orthopedic / adverse effects
  • Manipulation, Orthopedic / methods*
  • Middle Aged
  • Nerve Block
  • Postoperative Complications / physiopathology*
  • Postoperative Complications / therapy*
  • Range of Motion, Articular*
  • Rotation
  • Young Adult