What Is It and Why Does It Happen?
A clear, evidence-based overview for patients, athletes and clinicians
What does your elbow normally do?
Your elbow acts like a hinge:
Bending (flexion) and straightening (extension)
Rotating the forearm so your palm faces up (supination) or down (pronation)
A healthy elbow can move from 0 ° (fully straight) to about 145 ° (fully bent), but everyday tasks only need 30 – 130 °.
Small losses in movement rarely cause trouble, but if you cannot straighten beyond 30 ° or cannot bend past 130 °, you will probably notice it. Losing flexion usually bothers people more than losing the same amount of extension.
What is elbow stiffness?
Elbow stiffness is a loss of movement at the hinge-type elbow joint. Most daily tasks need an arc of 30 ° extension to 130 ° flexion and 50 ° pronation plus 50 ° supination. Falling outside that window-especially losing flexion-limits eating, dressing and reaching.
Intrinsic (intra-articular) causes – inside the joint
Common trigger | How it limits motion | Typical clues |
Post-traumatic osteoarthritis | Irregular joint surfaces and bone spurs block glide | History of fracture or dislocation; crepitus |
Primary osteoarthritis | Degenerative wear produces coronoid / olecranon osteophytes | Middle-aged manual worker; deep ache |
Inflammatory arthritis | Synovial thickening and capsular scarring | Warmth, swelling, morning stiffness |
Joint infection (post-septic) | Cartilage loss and fibrous ankylosis | Past sepsis, pain at rest |
Malunion / articular incongruity | “Step” in joint acts as mechanical stop | Visible deformity on X-ray or CT |
Loose bodies / OCD | Free fragments jam motion | Sudden locking episodes |
Protruding metalwork | Prominent screws impinge on capsule | Prior surgery, hardware visible |
Extrinsic (extra-articular) causes – outside the joint
- Capsular contracture – capsule thickens and shortens after bleeding or prolonged immobilisation.
- Ligament scarring – the posterior band of the medial ulnar collateral ligament often tethers flexion.
- Heterotopic ossification (HO) – new bone forms in soft tissue after trauma, burns or head injury, creating an actual bony bar.
- Skin or muscle contractures – burns, large scars or spasticity shorten soft tissues.
- Extra-articular malunion – angulated humeral or forearm fractures physically block movement.
- Neural adhesion – tethered ulnar nerve produces pain and protective guarding.
Reality check: most stiff elbows are mixed – an original intra-articular problem triggers extra-articular scarring if motion is delayed.
Why classification matters
- Intrinsic dominant → imaging (CT/3-D) to map bony blocks; arthroscopic or open debridement often required.
- Extrinsic dominant → physiotherapy and splinting have higher success; surgical capsular release if refractory.
- Mixed → staged approach: address bone, release capsule, then aggressive rehabilitation.
Can stiffness be prevented?
- Early, protected movement once fractures are stable – even gentle active motion reduces capsular fibrosis.
- Control swelling & inflammation – limb elevation, cryotherapy and short-course NSAIDs.
- HO prophylaxis in high-risk injuries – single-shot postoperative radiotherapy or 2-3 weeks of indomethacin.
- Avoid prolonged plaster; removable splints that allow guided exercise are preferable.
Clinical Pearls / Key Points
- <30 ° extension loss is usually tolerated; loss of flexion or rotation disables.
- After fracture-dislocation, start elbow motion within 7 days if the joint is stable.
- New bone around the posterior aspect restricting extension is often HO and may need excision.
- Always screen the ulnar nerve – adhesions or HO can trap it during flexion and must be released at surgery.
Patient FAQs
Question | Straightforward answer |
I can’t straighten my elbow after a cast – will it improve? | Many mild contractures (< 6 months) improve with guided exercises and night-time splints. Your therapist will set a plan. |
Why does my elbow “lock” suddenly? | A loose fragment of bone or cartilage can wedge in the joint. Imaging helps decide if removal is needed. |
Can tablets dissolve heterotopic bone? | Sadly no. NSAIDs and radiotherapy prevent new bone forming but established HO usually needs surgery if it blocks motion. |
Is keyhole surgery always possible? | Arthroscopy works well when stiffness is mainly capsular or spur-related. Extensive HO or severe deformity often needs an open approach. |
Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025