Arthroskopische Therapie bei steifem Ellenbogen

Elbow stiffness is often caused by a combination of intrinsic and extrinsic pathological joint alterations. The indications for operative treatment should be considered only after exhausting all conservative therapy options and after a thorough analysis of the etiology, evaluation of the affected structures and the individual requirements of the patient. Arthroscopic arthrolysis of the elbow joint has become established as the standard treatment of moderate functional deficits with a range of motion >60° in the extension-flexion plane and primarily intrinsic alterations, such as free joint bodies, intra-articular ossification and arthrofibrosis. All elbow joint compartments have to be structurally addressed to obtain the best operative outcome. In general, osseous obstacles are treated before the joint capsule is released. Furthermore, a test of joint stability by using a counterbrace is necessary to avoid relapse and treatment failure. Decompression of the ulnar nerve is recommended to avoid secondary nerve damage. Results of arthroscopic arthrolysis showed an improvement in the range of motion from 93° to 118° in 45 patients after 12 months. Close cooperation between the surgeon, patient and therapist is essential to maintain the achieved range of motion in the postoperative period. Postoperative management includes plexus anesthesia and adequate pain medication, frequent physiotherapy and continuous passive motion. Additionally, an extension orthosis is applied for 6 weeks.