Manipulation under Anesthesia for the Postsurgical Stiff Elbow: A Case Series

Background: 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 a viable option, in an attempt to obviate the need for surgical intervention. There is currently only limited data on the results of this procedure and its complications, especially in the setting of elbow joint stiffness.

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

Results: MUA was performed at a mean of 52 days (range 39-91 days) following the index surgery, 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.

Conclusion: 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.