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Biomechanical impact of elbow motion in elbow stiffness

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Abstract

Background

A mechanical block in the elbow due to osteophytes in the olecranon fossa is a common clinical symptom for elbow stiffness.

Purpose/hypothesis

This study aims to understand the biomechanical characteristics or changes in the stiff elbow in the resting (or neutral) and swing position of the arm using a cadaveric model. The hypotheses included the following: (1) a difference exists in the articular contact pressure of the elbow by comparing the non-stiff and stiff models in in vivo studies; (2) the degree of stiffness would affect the increase of the joint loading of the elbow.

Study design

Controlled laboratory study, cadaveric study.

Methods

Eight fresh-frozen specimens from individuals of both sexes were included in the biomechanical study. The specimen was mounted on a custom-designed jig system with gravity-assisted muscle contracture to mimic the elbow in a standing position. The elbow was tested in two conditions (the resting and passive swing). Contact pressure was recorded for three seconds in the resting position, which was the neutral position of the humerus. By dropping the forearm from 90° of the elbow flexion, the passive swing was performed. The specimens were tested sequentially in three stages of stiffness (stage 0, no stiffness; stage 1, 30° of extension limitation; and stage 2, 60° of extension limitation). After data collection was completed in stage 0, a stiff model was sequentially created for each stage. The stiff model of the elbow was created by blocking the olecranon by inserting a 2.0 K-wire into the olecranon fossa horizontally with the intercondylar axis.

Results

The mean contact pressures were 279 ± 23, 302 ± 6, and 349 ± 23 kPa in stages 0, 1, and 2, respectively. The increases in the mean contact pressure in stages 2 versus 0 were significant (P < 0.0001). The mean contact pressures were 297 ± 19, 310 ± 14, and 326 ± 13 kPa in stages 0, 1, and 2, respectively. The peak contact pressures were 420 ± 54, 448 ± 84, and 500 ± 67 kPa in stages 0, 1, and 2, respectively. The increases in mean contact pressure in stage 2 versus 0 were significant (P = 0.039). The increases in peak contact pressure in stages 0 versus 2 were significant (P = 0.007).

Conclusions

The elbow bears the load created by gravity and muscle contracture in the resting and swing motion. Moreover, extension limitation of stiff elbow increases the load bearing in the resting position and swing motion. Careful surgical management should be considered for meticulous clearance of bony spur around olecranon fossa to resolve the extension limitation of the elbow.

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF-2021R1G1A1095581).

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, College of Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea

    Jae-Man Kwak

  2. Shoulder and Elbow Clinic, Daejeon Woori Hospital, Daejeon, South Korea

    Kwang Won Lee

  3. Department of Orthopedic Surgery, College of Medicine, Gyeongsang National University, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea

    Gu-Hee Jung

  4. Department of Orthopedic Surgery, Faculty of Medicine, Universitas Trisakti, St Carolus Hospital, Jakarta, Indonesia

    Erica Kholinne

  5. Department of Anatomy, College of Medicine, Ulsan University, Seoul, Korea

    Seung Jun Hwang

  6. Department of Orthopedic Surgery, College of Medicine, Asan Medical Center, Ulsan University, Seoul, South Korea

    Kyoung Hwan Koh & In-ho Jeon

Authors
  1. Jae-Man Kwak
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  2. Kwang Won Lee
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  3. Gu-Hee Jung
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  4. Erica Kholinne
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  6. Kyoung Hwan Koh
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  7. In-ho Jeon
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Contributions

Conceptualization: G Jung and J Kwak. Data curation: E Kholinne and J Kwak. Formal analysis: J Kwak. Funding acquisition: I Jeon and J Kwak. Investigation: I Jeon. Methodology: G Jung, E Kholinne, and J Kwak. Project administration: I Jeon. Resources: I Jeon. Software: E Kholinne. Supervision: I Jeon and G Lee. Validation: G Jung and E Kholinne. Visualization: J Kwak. Writing — original draft: J Kwak. Writing — review and editing: G Jung, E Kholinne, I Jeon, G Lee.

Corresponding author

Correspondence to In-ho Jeon.

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AMC IRB S2020-3130–0001.

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The authors declare no competing interests.

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This paper includes contents of the doctoral dissertation by the same author(s) below: https://oak.ulsan.ac.kr/bitstream/2021.oak/5806/2/200000507968.pdf.

Primary location where this investigation was performed at Asan Medical Center, Seoul, Korea.

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Kwak, JM., Lee, K.W., Jung, GH. et al. Biomechanical impact of elbow motion in elbow stiffness. International Orthopaedics (SICOT) 47, 1779–1786 (2023). https://doi.org/10.1007/s00264-023-05781-2

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