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.
Literatur
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
Ball CM, Meunier M, Galatz LM et al (2002) Arthroscopic treatment of post-traumatic elbow contracture. J Shoulder Elbow Surg 11:624–629
Cefo I, Eygendaal D (2011) Arthroscopic arthrolysis for posttraumatic elbow stiffness. J Shoulder Elbow Surg 20:434–439
Cooney Wpi MBCOTES, Philadelphia (1993) Contractures of the elbow. Saunders, Philadelphia
Degreef I, De Smet L (2011) Elbow arthrolysis for traumatic arthrofibrosis: a shift towards minimally invasive surgery. Acta Orthop Belg 77:758–764
Dexel JKP (2013) Arthroskopie des Ellenbogens. Obere Extremität 8:2–8
Dickson RA (1976) Reversed dynamic slings. A new concept in the treatment of post-traumatic elbow flexion contractures. Injury 8:35–38
Doornberg JN, Ring D, Jupiter JB (2006) Static progressive splinting for posttraumatic elbow stiffness. J Orthop Trauma 20:400–404
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
Froimson AI, Silva JE, Richey D (1976) Cutis arthroplasty of the elbow joint. J Bone Joint Surg Am 58:863–865
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
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
Jupiter JB, O’driscoll SW, Cohen MS (2003) The assessment and management of the stiff elbow. Instr Course Lect 52:93–111
Kaplan FS, Glaser DL, Hebela N et al (2004) Heterotopic ossification. J Am Acad Orthop Surg 12:116–125
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
Kay NR (1998) Arthrolysis of the post-traumatic stiff elbow. In: Stanley DKN (Hrsg) Surgery of the elbow. Arnold, London, S 228–234
Kim SJ, Shin SJ (2000) Arthroscopic treatment for limitation of motion of the elbow. Clin Orthop Relat Res(375):140–148
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
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
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
Morrey BF (1993) Distraction arthroplasty. Clinical applications. Clin Orthop Relat Res (293):46–54
Morrey BF (1990) Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am 72:601–618
Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 63:872–877
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
Nguyen D, Proper SI, Macdermid JC et al (2006) Functional outcomes of arthroscopic capsular release of the elbow. Arthroscopy 22:842–849
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
Phillips BB, Strasburger S (1998) Arthroscopic treatment of arthrofibrosis of the elbow joint. Arthroscopy 14:38–44
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
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
Ring D, Adey L, Zurakowski D et al (2006) Elbow capsulectomy for posttraumatic elbow stiffness. J Hand Surg Am 31:1264–1271
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
Schaeffeler C, Waldt S, Woertler K (2013) Traumatic instability of the elbow – anatomy, pathomechanisms and presentation on imaging. Eur Radiol 23:2582–2593
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
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
Somanchi BV, Funk L (2008) Evaluation of functional outcome and patient satisfaction after arthroscopic elbow arthrolysis. Acta Orthop Belg 74:17–23
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
Stehle J, Gohlke F (2011) Classification of elbow stiffness and indications for surgical treatment. Orthopade 40:282–290
Tan V, Daluiski A, Simic P et al (2006) Outcome of open release for post-traumatic elbow stiffness. J Trauma 61:673–678
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
Van Zeeland NL, Yamaguchi K (2010) Arthroscopic capsular release of the elbow. J Shoulder Elbow Surg 19:13–19
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
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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