A reflective essay by Bernard Morrey — 'Mr. Elbow' — distilling 40+ years of surgical practice. No data are presented; this is expert synthesis across four domains: medicine, orthopedics, the elbow, and life. It is a reference piece for surgical philosophy and clinical decision-making, not a clinical trial.
The elbow is capricious — Morrey's own word. And its complexity rewards a systematic approach over reflexive imaging or surgery. When you see an elbow with alarming radiographs but preserved radiohumeral congruency and medial trochlear stability, resist the urge to intervene. Appearance does not equal dysfunction, and operating on a functioning joint rarely improves it.
When you see a patient with progressive elbow stiffness after minor surgery or trivial trauma, recognize that this is a biological process. Release the contracture surgically, but counsel the patient that the underlying tendency is not corrected by the procedure.
The 3-variable optimization framework is a practical tool: before every elbow case, ask whether you are doing the least surgery that meets the patient's goals at the lowest complication risk. If you cannot answer yes to all three, reconsider the plan.
A reflective essay by Bernard Morrey — 'Mr. Elbow' — distilling 40+ years of surgical practice. No data are presented; this is expert synthesis across four domains: medicine, orthopedics, the elbow, and life. It is a reference piece for surgical philosophy and clinical decision-making, not a clinical trial.
The elbow is capricious — Morrey's own word. And its complexity rewards a systematic approach over reflexive imaging or surgery. When you see an elbow with alarming radiographs but preserved radiohumeral congruency and medial trochlear stability, resist the urge to intervene. Appearance does not equal dysfunction, and operating on a functioning joint rarely improves it.
When you see a patient with progressive elbow stiffness after minor surgery or trivial trauma, recognize that this is a biological process. Release the contracture surgically, but counsel the patient that the underlying tendency is not corrected by the procedure.
The 3-variable optimization framework is a practical tool: before every elbow case, ask whether you are doing the least surgery that meets the patient's goals at the lowest complication risk. If you cannot answer yes to all three, reconsider the plan.