The outcome of examination (manipulation) under anesthesia on the stiff elbow after surgical contracture release

Hypothesis

We have used a technique of elbow examination under anesthesia in select patients after surgical release to assess the smoothness of the articulation, evaluate stability, and to stretch the flexion and rotation arcs.

Materials and methods

The study comprised 51 consecutive patients who underwent an examination under anesthesia between January of 1996 and December of 2001.

Results

The examination occurred a mean of 40 days after surgery. Forty-four patients with a minimum of 12 months follow-up revealed a mean pre-examination arc of 33°, which improved to 73° at the final assessment. Three patients had no appreciable change (<10°) in the total arc, and 1 patient lost motion. Four patients underwent a second examination under anesthesia at a mean of 119 days after the first examination. The average pre-examination arc of 40° increased to 78° at the final assessment (mean improvement, 38°). The only complication was worsening of ulnar paresthesias in 3; with 2 resolving spontaneously, and 1 patient requiring anterior ulnar nerve transposition.

Conclusions

Examination (manipulation) under anesthesia can be a valuable adjunctive procedure to help regain the motion obtained at the time of surgical release. Because this was not a controlled series, additional studies might be conducted to refine those not benefiting from this procedure. In our series no permanent complications were noted.

Level of evidence: Level IV, Case Series, Treatment Study

Keywords: Stiff elbow, examination under anesthesia