Elbow stiffness-importance of conservative treatment

Background: Functional limitations of the elbow, as in the case of arthrofibrosis, can lead to far-reaching negative effects in everyday life and at work. Early diagnosis and initiation of therapy play an important role in minimizing the risk of elbow stiffness. Objective: The following study focuses on the possibilities of conservative therapy for elbow stiffness and its associated outcome. Materials and methods: The article is divided into two main parts. In the first part, the results of a systemic literature search are described regarding therapeutic options with a focus on physiotherapy, orthotic treatment, continuous passive motion as well as alternative treatment methods. In the second part, the basics of a physiotherapeutic algorithm are presented, which includes the main components of a treatment plan. Results: Myofibroblasts represent key cells that initiate fibrotic processes. The aim of conservative therapy is to inhibit this remodeling process and, thus, prevent elbow stiffness. Conservative therapy approaches include physiotherapy with exercise and mobilization, the use of continuous passive motion and static and dynamic orthoses. Injections with botulinum toxin A are also occasionallymentioned in the literature. The majority of patients (similar to 80%) regain their functional range of motion within 12 months after elbow trauma through conservative therapy measures. Mobilization as early as possible after trauma or surgery is the best way to reduce the risk of elbow stiffness. The importance of physiotherapy and the overall evidence base for continuous passive motion and orthotic treatment is very low, but shows a trend to improve functional outcome. Conclusion: Despite the growing understanding in diagnosis and treatment of complex elbow injuries, arthrofibrosis remains a common and underestimated complication. The underlying etiopathogenesis is still not fully understood. Compared to the number of studies on surgical therapies for elbow stiffness, there is rather a lack of scientific work on conservative therapies.