The elbow is a hinge joint connecting the humerus (upper arm bone) with the radius and ulna (forearm bones). Normal function allows for a wide range of motion, primarily involving flexion (bending the arm) and extension (straightening it). Full flexion typically reaches between 140 to 150 degrees, which is necessary for daily activities like eating or bringing a hand to the face. When this range of motion is restricted, it signals a physical problem within the joint or the surrounding soft tissues that requires careful evaluation.
Acute Causes of Range Restriction
A sudden loss of the ability to bend the elbow often follows a traumatic event, resulting from mechanical blockage or severe swelling. Fractures of the bones forming the joint, particularly intra-articular fractures, can cause bone fragments to obstruct the smooth gliding motion required for full flexion. These fragments or misplaced bone ends act as a stop within the joint space, preventing the forearm from moving closer to the upper arm.
A joint dislocation, where the bones are forced out of alignment, is another common acute cause. Even after successful repositioning, damage to stabilizing ligaments and the joint capsule leads to significant inflammation and swelling. This immediate post-injury swelling, potentially including a collection of blood (hemarthrosis), creates pressure that limits movement. The body’s protective response to the trauma also includes muscle guarding and pain, which further inhibit any attempt at full range of motion.
Post-surgical stiffness is also considered an acute restriction following an operation. The necessary period of immobilization to allow tissues to heal quickly leads to a buildup of scar tissue and a tightening of the joint capsule. This rapid formation of restrictive soft tissue limits the arc of motion, making it difficult to fully bend the arm soon after the splint or sling is removed. This acute stiffness demands early, controlled movement to prevent a long-term contracture.
Chronic Conditions That Limit Movement
Limitations in elbow bending can develop gradually over time due to degenerative or inflammatory processes. Osteoarthritis, where the protective cartilage wears down, causes pain and friction that restricts motion. As the joint attempts to stabilize itself, it can form bony growths called osteophytes, or bone spurs, particularly in the coronoid and olecranon fossae of the humerus. These spurs can mechanically collide, or “impinge,” preventing the arm from achieving full flexion or extension.
Rheumatoid arthritis is a systemic inflammatory disease that targets the joint lining, causing chronic inflammation and eventual erosion of cartilage and bone. The resulting joint damage and thickened, scarred synovial tissue can severely restrict the elbow’s ability to move freely. Heterotopic ossification is another long-term issue, involving the abnormal formation of new bone in the soft tissues surrounding the joint, such as the muscle or joint capsule. This ectopic bone acts like a rigid internal splint, progressively reducing the range of motion, often following a severe burn or traumatic brain injury.
Soft tissue contractures and fibrosis result from prolonged immobilization or repeated microtrauma. When the joint is held still for an extended period, the collagen fibers within the joint capsule and surrounding ligaments shorten and become less pliable. This tightening creates a functional tether, preventing the muscles from pulling the forearm into a full bend. These chronic changes are insidious and cause a slow but steady decrease in the functional arc of movement.
Immediate Steps and Home Management
If the restriction is mild and not associated with severe pain or deformity, initial home management can help address swelling and discomfort. The RICE protocol is a standard first-aid approach for acute soft tissue swelling:
- Rest
- Ice
- Compression
- Elevation
Applying an ice pack for 15 to 20 minutes several times a day can help reduce inflammation, while elevating the arm above the level of the heart encourages fluid drainage.
Gentle, passive range-of-motion exercises can be helpful to maintain flexibility, provided they are performed without forcing the joint or causing sharp pain. This involves using the opposite hand to slowly move the affected elbow into flexion until a mild stretch is felt. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be used to manage pain and reduce generalized inflammation. A healthcare professional should be consulted if movement restriction is significant, worsening, or fails to improve within a few days.
Professional Diagnosis and Treatment Options
A sudden loss of movement accompanied by a visible deformity, numbness or tingling in the hand, or signs of infection like fever, requires immediate medical attention. These are considered red flags that may indicate a severe fracture, nerve compression, or a vascular compromise. For any persistent or significant restriction, a professional diagnosis begins with a physical examination to assess the quality and extent of the limited motion.
Imaging studies are routinely used to identify the underlying cause of the restriction. X-rays can clearly show fractures, joint misalignment, bony spurs, or heterotopic ossification. If soft tissue damage, such as ligament tears, joint capsule scarring, or loose bodies, is suspected, a Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan may be ordered. The CT scan is particularly useful for detailed visualization of complex fracture patterns or the location of obstructing bone.
Non-surgical treatment is often the first line of intervention, with physical therapy being central to restoring motion. A therapist uses targeted exercises, joint mobilization techniques, and stretching to carefully increase the elbow’s range of motion. Corticosteroid injections may be administered directly into the joint space to reduce severe inflammation and pain, temporarily improving the environment for movement.
If conservative methods fail, surgical interventions are considered to physically remove the block to motion. Arthroscopic surgery, a minimally invasive procedure, can be used to remove loose bodies, shave down obstructing osteophytes, or release scar tissue from the joint capsule. For complex cases involving severe joint destruction from arthritis or poorly healed fractures, open surgery may be necessary to reconstruct the joint, or in the most severe scenarios, a total elbow replacement may be performed to restore a functional range of motion.