抄録
There is no fixed“functional position”of the elbow joint, because flexion at least to 115°and extension to-40°is mandatory to make the hand reach to both ends of GI-tract, i. e., for the upper limb to be useful.
Operative mobilization of the stiff elbow joint can be classified into 4 types corresponding to the characteristic features of the pathology causing the contracture.
(1) Capsular and ligamentous release, (2) joint toilet in cases with the synovial proliferation and cicatrization occasionally associated with free bodies and osteophytes., (3) resection interposition arthroplasty, or (4) replacement with an artificial joint in cases with extensive cartilage damage and fibrous or bony ankylosis.
In type 1 and 2 operations, posterior approach in which temporary severance of triceps insertion to the olecranon preserves tendinous continuity to the forearm, is recommended to cope with extension or combined extension and flexion contracture, and a less extensive lateral approach in flexion contracture with the added medial approach if needed.
The aimed for ROM has to be acquired during operative procedure, because increase of ROM by postoperative exercise is unpredictable. However, elongation of triceps or biceps should be avoided whenever possible.
Early postoperative full ROM exercise after type 1, 2 and 3 operations by means of the author's“ self-controlled passive motion”system or motor-driven“continuous passive motion”assures reaching the final goal of ROM whithin one month and possibly better final ROM.
Type 3 operation is still useful for mobilizing the elbow joint, because an ideal artifical elbow joint has not yet been produced.
After type 3 and 4 operations, careful protective use of the mobilized elbow joint is mandatory to maintain the improved ROM.
