Initial pre-referral workup

Clinical history

• previous trauma
• congenital differences in other areas

Physical examination

Check for difference between active and passive range of motion.

Investigations

X-ray

GP management

Elbow stiffness can have multiple causes. It can occur following normal healing of fractures but may also be due to malunions or missed injuries.

If healing on x-ray is appropriate, and patient has just come out of cast, then a few weeks of stiffness is expected. Physiotherapy can be helpful in most cases.

Indications for specialist referral

Routine

• arthrofibrosis (excessive joint scarring), without evidence of missed injury or malunion of previous fractures, not responding to physiotherapy
• malunited fracture
• congenital malformations in elbow
• osteochondritis dissecans of the elbow