This document describes a case of open arthrolysis performed on a 35-year old male farmer who presented with a stiff elbow of unusual etiology. An MRI revealed a soft tissue mass in the superior radioulnar joint. During open arthrolysis, an intra-articular ganglion was found and removed from the superior radioulnar joint. Post-operatively, the patient underwent physical therapy and elbow mobilization exercises to regain range of motion, achieving near full extension and flexion after six months with minimal pain.

1. OPEN ARTHROLYSIS FOR A STIFF
ELBOW BECAUSE OF AN
UNUSUAL ETIOLOGY
PRASHANT UPADHYAYA
DNB RESIDENT
UNIQUE SUPERSPECIALITY HOSPITAL
INDORE
JAYANT SHARMA
M.S,D.N.B,M.N.A.M.S.
www.drjayantsharma.com

2. THE PRESENCE OF THREE ARTICULATION WITH
A SINGLE SYNOVIAL TISSUE LINED CAPSULE
AND CLOSE PROXIMITY OF THE JOINT
CAPSULE TO THE LIGAMENTS AND
EXTRACAPSULAR MUSCLES AND THE
INTRINSIC CONGRUITY OF HUMEROULNAR
ARTICULATION PREDISPOSE TO STIFFNESS.

3. • THE POSITION OF MINIMAL
INTRAARTICULAR PRESSURE AND MAXIMUM
COMPLIANCE OF NORMAL ELBOW(RESTING
POSITION) IS 70 DEGREES.
• IF THE ELBOW IS IMMOBILIZED IN THIS
POSITION FOR AN EXTENDED PERIOD OF
TIME, THE RISK OF ELBOW JOINT CAPSULE,
CONTRACTURE MIGHT INCREASE

4. • CAUSES OF STIFFNESS
• INTRINSIC= INTRA ARTICULAR-
• POST TRAUMATIC ARTHRITIS,
INCONGRUITY,ANKYLOSIS,ADHESION,LOOSE
BODIES, BONE SPURS, SYNOVITIS
• EXTRINSIC= HETEROTROPHIC OSSIFICATION,
MUSCULOTENDINOUS CONTRACTURES

5. • IF A PATIENT HAS AN EXTENSION DEFORMITY
OF MORE THAN 30 DEGREE AND FLEXION OF
LESS THAN 130 DEGREE FOR A PERIOD OF
MORE THAN 6 MONTHS POST INJURY
SHOULD BE CONSIDERED FOR ARTHROLYSIS.

6. PRESENT CASE
• OUR PATIENT WAS A FARMER, 35 YEAR OLD
MALE WITH NO HISTORY OF ANY FRACTURE OR
MAJOR TRAUMA.
• PRESENTED WITH RESTRICTED MOVEMENTS AT
ELBOW AND TINGLING ALONG INNER SIDE OF
FOREARM. GRADUALLY INCREASING OVER A
PERIOD OF SIX MONTHS
• TOOK MASSAGE AND PHYSIOTHERAPY BOTH,
WITH FURTHER INCREASE IN PAIN IN FRONT OF
ELBOW

7. RESTRICTED
EXTENSION(LAG)
PASSIVE UPTO 80
DEGREES

8. ACTIVE EXTENSION LAG
OF 70 DEGREES
FLEXION OF 110
DEGREES

9. XRAY WAS NOT
VERY CONCLUSIVE
OF ANY MYOSITIS/
OLD FRACTURE
MALUNION
OLECRENON
OSTEOPHYTOSIS
NOTED AND
SCLEROSIS
AROUND RADIAL
TUBEROSITY

10. MRI REVEALED
LATERAL CONDYLAR
DEGENERATION AND A
?SOFT TISSUE MASS IN
SUPERIOR
RADIOULNAR JOINT

11. OPEN ARTHROLYSIS PERFORMED USING EXTENSIVE LATERAL AND
MEDIAL INCISION.
LATERAL APPROACH- RELEASE CAPSULE, LATERAL COLLATERAL
LIGAMENTS CUT.
INTRA ARTICULAR GANGLION FOUND AT THE LEVEL OF SUPERIOR
RADIOULNAR JOINT.
TRICEPS AND BRACHIALIS TENOLYSIS DONE
INTRA
ARTICULAR
GANGLION

12. AFTER RELEASE OF TIGHT BAND
ULNAR NERVE WAS RELEASED AND
ANTERIORLY TRASNSPOSED IN A
FASCIAL TUNNEL CREATED.
ULNAR
NERVE

13. POST OPERATIVE ASSESMENT
OF RANGE OF MOTION IS
DONE ON TABLE

14. • POST OPERATIVE PROTOCOL
• STITCH REMOVAL ON 10TH POST OPERATIVE DAY
• ACTIVE RANGE OF MOVEMENT EXERCISES
STARTED
• ELBOW MOBILIZATION BRACE GIVEN
• PHYSIOTHERAPY WAS THE MAIN STAY IN
OBTAINING EXCELLENT RESULT

15. AT THE END OF SIX MONTHS THE RANGE OF MOTION WAS ASSESED
WITH ALMOST FULL FUNCTIONAL LEVEL OF EXTENSION AND FLEXION
ARCH.
VAS OF THE PATIENT WAS BETWEEN 0 TO 2 FOR TOUCH ,PIN PRICK
AND PRESSURE.

16. REFERENCES