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Ellenbogenkontraktur

Wann sollte arthroskopisch, wann offen vorgegangen werden?

Elbow contracture

Use of an arthroscopic procedure or an open procedure?

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Zusammenfassung

Die Bewegungseinschränkung des Ellenbogens kann intrinsische und extrinsische Ursachen haben und tritt meist posttraumatisch auf. Ziel dieses Artikels ist es einerseits dem Leser aufzuzeigen, wann diese Kontrakturen mittels arthroskopischer Techniken suffizient gelöst werden können. Auf der anderen Seite werden die Grenzen der Arthroskopie und die Indikationen zum offenen Vorgehen besprochen. Eine kurze Technikbeschreibung und mögliche Komplikationen werden aufgezeigt. Ein möglicher Algorithmus in der Behandlung der Ellenbogensteife wird vorgestellt.

Abstract

Limited range of motion of the elbow joint is caused by intrinsic and extrinsic causes and most often occur after trauma to the elbow. The reasons for contracture as well as the differential indication for arthroscopic and open procedures are discussed. Technical considerations and complications are presented; a possible treatment algorithm is introduced.

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Literatur

  1. Ayadi D, Etienne P, Burny F et al (2011) Results of open arthrolysis for elbow stiffness. A series of 22 cases. Acta Orthop Belg 77:453–457

    PubMed  Google Scholar 

  2. Ball CM, Meunier M, Galatz LM et al (2002) Arthroscopic treatment of post-traumatic elbow contracture. J Shoulder Elbow Surg 11:624–629

    Article  PubMed  Google Scholar 

  3. Cefo I, Eygendaal D (2011) Arthroscopic arthrolysis for posttraumatic elbow stiffness. J Shoulder Elbow Surg 20:434–439

    Article  PubMed  Google Scholar 

  4. Cooney Wpi MBCOTES, Philadelphia (1993) Contractures of the elbow. Saunders, Philadelphia

  5. Degreef I, De Smet L (2011) Elbow arthrolysis for traumatic arthrofibrosis: a shift towards minimally invasive surgery. Acta Orthop Belg 77:758–764

    PubMed  Google Scholar 

  6. Dexel JKP (2013) Arthroskopie des Ellenbogens. Obere Extremität 8:2–8

    Article  Google Scholar 

  7. Dickson RA (1976) Reversed dynamic slings. A new concept in the treatment of post-traumatic elbow flexion contractures. Injury 8:35–38

    Article  PubMed  CAS  Google Scholar 

  8. Doornberg JN, Ring D, Jupiter JB (2006) Static progressive splinting for posttraumatic elbow stiffness. J Orthop Trauma 20:400–404

    Article  PubMed  Google Scholar 

  9. Ellerin BE, Helfet D, Parikh S et al (1999) Current therapy in the management of heterotopic ossification of the elbow: a review with case studies. Am J Phys Med Rehabil 78:259–271

    Article  PubMed  CAS  Google Scholar 

  10. Froimson AI, Silva JE, Richey D (1976) Cutis arthroplasty of the elbow joint. J Bone Joint Surg Am 58:863–865

    PubMed  CAS  Google Scholar 

  11. Gelberman RH, Yamaguchi K, Hollstien SB et al (1998) Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavera. J Bone Joint Surg Am 80:492–501

    PubMed  CAS  Google Scholar 

  12. Gelinas JJ, Faber KJ, Patterson SD et al (2000) The effectiveness of turnbuckle splinting for elbow contractures. J Bone Joint Surg Br 82:74–78

    Article  PubMed  CAS  Google Scholar 

  13. Jupiter JB, O’driscoll SW, Cohen MS (2003) The assessment and management of the stiff elbow. Instr Course Lect 52:93–111

    PubMed  Google Scholar 

  14. Kaplan FS, Glaser DL, Hebela N et al (2004) Heterotopic ossification. J Am Acad Orthop Surg 12:116–125

    PubMed  Google Scholar 

  15. Katolik LI, Cohen MS (2009) Anterior interosseous nerve palsy after open capsular release for elbow stiffness: report of 2 cases. J Hand Surg Am 34:288–291

    Article  PubMed  Google Scholar 

  16. Kay NR (1998) Arthrolysis of the post-traumatic stiff elbow. In: Stanley DKN (Hrsg) Surgery of the elbow. Arnold, London, S 228–234

  17. Kim SJ, Shin SJ (2000) Arthroscopic treatment for limitation of motion of the elbow. Clin Orthop Relat Res(375):140–148

  18. Kulkarni GS, Kulkarni VS, Shyam AK et al (2010) Management of severe extra-articular contracture of the elbow by open arthrolysis and a monolateral hinged external fixator. J Bone Joint Surg Br 92:92–97

    Article  PubMed  CAS  Google Scholar 

  19. Lindenhovius AL, Van De Luijtgaarden K, Ring D et al (2009) Open elbow contracture release: postoperative management with and without continuous passive motion. J Hand Surg Am 34:858–865

    Article  PubMed  Google Scholar 

  20. Mansat P, Morrey BF (1998) The column procedure: a limited lateral approach for extrinsic contracture of the elbow. J Bone Joint Surg Am 80:1603–1615

    PubMed  CAS  Google Scholar 

  21. Morrey BF (1993) Distraction arthroplasty. Clinical applications. Clin Orthop Relat Res (293):46–54

  22. Morrey BF (1990) Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am 72:601–618

    PubMed  CAS  Google Scholar 

  23. Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 63:872–877

    PubMed  CAS  Google Scholar 

  24. Morrey BF, Larson AN (2009) Interposition arthroplasty of the elbow. In: Morrey BF, Sabchez-Sotelo J (Hrsg) The elbow and its disorders. Saunders, Philadelphia, S 935–948

  25. Nguyen D, Proper SI, Macdermid JC et al (2006) Functional outcomes of arthroscopic capsular release of the elbow. Arthroscopy 22:842–849

    Article  PubMed  Google Scholar 

  26. Park MJ, Chang MJ, Lee YB et al (2010) Surgical release for posttraumatic loss of elbow flexion. J Bone Joint Surg Am 92:2692–2699

    Article  PubMed  Google Scholar 

  27. Phillips BB, Strasburger S (1998) Arthroscopic treatment of arthrofibrosis of the elbow joint. Arthroscopy 14:38–44

    Article  PubMed  CAS  Google Scholar 

  28. Raiss P, Rettig O, Wolf S et al (2007) Range of motion of shoulder and elbow in activities of daily life in 3D motion analysis. Z Orthop Unfall 145:493–498

    PubMed  CAS  Google Scholar 

  29. Richard R, Shanesy CP 3rd, Miller SF (1995) Dynamic versus static splints: a prospective case for sustained stress. J Burn Care Rehabil 16:284–287

    Article  PubMed  CAS  Google Scholar 

  30. Ring D, Adey L, Zurakowski D et al (2006) Elbow capsulectomy for posttraumatic elbow stiffness. J Hand Surg Am 31:1264–1271

    Article  PubMed  Google Scholar 

  31. Savoie FH 3rd, Nunley PD, Field LD (1999) Arthroscopic management of the arthritic elbow: indications, technique, and results. J Shoulder Elbow Surg 8:214–219

    Article  PubMed  Google Scholar 

  32. Schaeffeler C, Waldt S, Woertler K (2013) Traumatic instability of the elbow – anatomy, pathomechanisms and presentation on imaging. Eur Radiol 23:2582–2593

    Article  PubMed  Google Scholar 

  33. Sharma S, Rymaszewski LA (2007) Open arthrolysis for post-traumatic stiffness of the elbow: results are durable over the medium term. J Bone Joint Surg Br 89:778–781

    Article  PubMed  CAS  Google Scholar 

  34. Shewring DJ, Beaudet M, Carvell JE (1991) Reversed dynamic slings: results of use in the treatment of post-traumatic flexion contractures of the elbow. Injury 22:400–402

    Article  PubMed  CAS  Google Scholar 

  35. Somanchi BV, Funk L (2008) Evaluation of functional outcome and patient satisfaction after arthroscopic elbow arthrolysis. Acta Orthop Belg 74:17–23

    PubMed  Google Scholar 

  36. Spielman G, Gennarelli TA, Rogers CR (1983) Disodium etidronate: its role in preventing heterotopic ossification in severe head injury. Arch Phys Med Rehabil 64:539–542

    PubMed  CAS  Google Scholar 

  37. Stehle J, Gohlke F (2011) Classification of elbow stiffness and indications for surgical treatment. Orthopade 40:282–290

    Article  PubMed  CAS  Google Scholar 

  38. Tan V, Daluiski A, Simic P et al (2006) Outcome of open release for post-traumatic elbow stiffness. J Trauma 61:673–678

    Article  PubMed  Google Scholar 

  39. Valero Gonzalez FS, Gutierrez Sevilla GR, Aguilera Zepeda JM et al (2008) Open surgical treatment in post-traumatic elbow stiffness. Acta Ortop Mex 22:228–232

    PubMed  Google Scholar 

  40. Van Zeeland NL, Yamaguchi K (2010) Arthroscopic capsular release of the elbow. J Shoulder Elbow Surg 19:13–19

    Article  PubMed  Google Scholar 

  41. Waldt S, Bruegel M, Ganter K et al (2005) Comparison of multislice CT arthrography and MR arthrography for the detection of articular cartilage lesions of the elbow. Eur Radiol 15:784–791

    Article  PubMed  CAS  Google Scholar 

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S. Lichtenberg gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to Sven Lichtenberg M.D..

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Lichtenberg, S. Ellenbogenkontraktur. Obere Extremität 9, 163–171 (2014). https://doi.org/10.1007/s11678-014-0279-8

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  • DOI: https://doi.org/10.1007/s11678-014-0279-8

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