This retrospective cohort study examined 46 adults treated with open elbow capsulectomy for posttraumatic stiffness. The goal was to identify which factors — motion, pain, or ulnar nerve status — best predict functional outcomes and patient-reported health status after surgery.
When counseling a patient before elbow capsulectomy, the conversation about outcomes needs to go beyond motion. This study shows that patient-reported quality of life after elbow release is determined by two things: residual pain and ulnar nerve status. A patient who regains 110° of motion but has persistent ulnar neuropathy will still score poorly on the DASH.
The ulnar nerve deserves specific attention at every stage. If preoperative neuropathy is present, a medial approach with neurolysis and subcutaneous transposition is indicated. If a lateral approach is used in a nerve-intact patient, counsel them that new ulnar neuropathy develops in roughly 1 in 6 cases — typically months later, not immediately. And may not resolve even with subsequent nerve surgery.
Manage expectations around repeat releases carefully. A second capsulectomy adds only about 24° on average, and patients who need one already have worse baseline trajectories. Offering a repeat release is reasonable, but framing it as a major functional reset is not supported by the data.
This retrospective cohort study examined 46 adults treated with open elbow capsulectomy for posttraumatic stiffness. The goal was to identify which factors — motion, pain, or ulnar nerve status — best predict functional outcomes and patient-reported health status after surgery.
When counseling a patient before elbow capsulectomy, the conversation about outcomes needs to go beyond motion. This study shows that patient-reported quality of life after elbow release is determined by two things: residual pain and ulnar nerve status. A patient who regains 110° of motion but has persistent ulnar neuropathy will still score poorly on the DASH.
The ulnar nerve deserves specific attention at every stage. If preoperative neuropathy is present, a medial approach with neurolysis and subcutaneous transposition is indicated. If a lateral approach is used in a nerve-intact patient, counsel them that new ulnar neuropathy develops in roughly 1 in 6 cases — typically months later, not immediately. And may not resolve even with subsequent nerve surgery.
Manage expectations around repeat releases carefully. A second capsulectomy adds only about 24° on average, and patients who need one already have worse baseline trajectories. Offering a repeat release is reasonable, but framing it as a major functional reset is not supported by the data.