This review describes arthroscopic management of the stiff elbow, focusing on capsular release for contractures resistant to nonsurgical care. It covers indications, contraindications, surgical technique, and neurovascular pitfalls. The emphasis is on protecting the ulnar and radial nerves while restoring a functional arc of motion.
The single decision that keeps you out of trouble: check preoperative flexion. If it is 90 to 100 degrees or less, decompress the ulnar nerve and release the contracted posterior MUCL bundle before you manipulate the elbow into flexion.
The mechanism is testable. Flexion beyond 90 degrees narrows the cubital tunnel and raises intraneural pressure, and the posterior MUCL forms the tunnel floor. Restore flexion without addressing it and you tension the nerve.
Know your nerve safe zones. The deep radial nerve sits against the anterior capsule distally, so release the lateral capsule 2 to 3 cm proximal to the radial head and favor proximal portals.
Set expectations honestly. This is a narrative review of small, heterogeneous, short-term series, and outcomes favor mild-to-moderate posttraumatic stiffness with minimal heterotopic bone. Motion is made functional, not normal.
This review describes arthroscopic management of the stiff elbow, focusing on capsular release for contractures resistant to nonsurgical care. It covers indications, contraindications, surgical technique, and neurovascular pitfalls. The emphasis is on protecting the ulnar and radial nerves while restoring a functional arc of motion.
The single decision that keeps you out of trouble: check preoperative flexion. If it is 90 to 100 degrees or less, decompress the ulnar nerve and release the contracted posterior MUCL bundle before you manipulate the elbow into flexion.
The mechanism is testable. Flexion beyond 90 degrees narrows the cubital tunnel and raises intraneural pressure, and the posterior MUCL forms the tunnel floor. Restore flexion without addressing it and you tension the nerve.
Know your nerve safe zones. The deep radial nerve sits against the anterior capsule distally, so release the lateral capsule 2 to 3 cm proximal to the radial head and favor proximal portals.
Set expectations honestly. This is a narrative review of small, heterogeneous, short-term series, and outcomes favor mild-to-moderate posttraumatic stiffness with minimal heterotopic bone. Motion is made functional, not normal.