Hombro y codo

Capsulectomía de hombro para la rigidez de codo postraumático. (I)

David Ring MD, a, , Lauren Adey MDa, David Zurakowski PhDa and Jesse B. Jupiter MDa aDepartment of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

Purpose To determine factors associated with diminished elbow function and upper-extremity–specific health status after elbow capsulectomy for posttraumatic stiffness.

Methods Forty-six adult patients with posttraumatic elbow stiffness were evaluated an average of 48 months after open capsular excision. A second capsular excision was performed in 9 patients (29%). Stepwise multiple linear regression analysis was used to identify predictors of the American Shoulder and Elbow Surgeons Elbow Score, the Mayo Elbow Performance Index, and the Disabilities of the Arm, Shoulder, and Hand scores after all procedures.

Results The average improvement in ulnohumeral motion after the index surgery for capsular release was 53°. (The average flexion was 98°.) The 9 patients who had subsequent repeat elbow contracture release gained an additional 24°, leading to a final average flexion arc for the entire cohort of 103°. Multiple linear regression identified the American Shoulder and Elbow Surgeons pain score, persistent ulnar nerve dysfunction, and duration of follow-up evaluation after the initial capsular release as independent predictors of a higher Disabilities of the Arm, Shoulder, and Hand questionnaire score; flexion arc and pain score as independent predictors of the Mayo Elbow Performance Index; and flexion arc, forearm arc, pain score, and persistent ulnar neuropathy as independent predictors of the American Shoulder and Elbow Surgeons score.

Conclusions Open elbow capsulectomy for posttraumatic elbow stiffness restores a near-100° flexion arc on average. Second elbow releases provide limited additional motion in most patients. Final motion influences physician-based rating scales but not patient-specific health status (Disabilities of the Arm, Shoulder, and Hand questionnaire), which is dominated by pain and persistent ulnar neuropathy.

The Journal of Hand Surgery. Volume 31, Issue 8 , October 2006, Pages 1264-1271.

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