Przejdź do treściLoss of full elbow extension can result from pain and swelling after injury, capsular contracture, scar tissue, osteoarthritis, a loose body or a fracture that has healed in an abnormal position. If the restriction appears suddenly after trauma, the elbow should not be forcibly stretched before fracture, dislocation or a mechanical block has been excluded.
What does a stiff elbow mean?
The elbow allows the arm to bend and straighten and the forearm to rotate palm-up and palm-down. Even a relatively small loss of motion can interfere with eating, personal care, dressing, computer work or reaching the face. The functional effect therefore matters as much as the number of degrees lost.
Some healthy people have a small, stable difference in extension between sides. New loss of motion, progressive restriction, pain, locking or functional decline is more concerning.
Why might the elbow not fully straighten?
Swelling and pain after a recent injury
After a fall or direct blow, movement may be limited by a joint effusion, haematoma, bruising, fracture or dislocation. Inability to fully extend the elbow after trauma increases suspicion of an injury that may require imaging. The fact that the arm can still move does not exclude a fracture.
Contracture after immobilisation or surgery
The elbow is particularly prone to stiffness. After a fracture, dislocation or operation, the joint capsule may thicken and shorten and scar tissue may restrict tissue glide. Prolonged immobilisation increases the risk, although the timing of mobilisation must always respect the stability of repaired structures.
A bony obstacle or loose fragment
Osteophytes from osteoarthritis, malunited fracture, heterotopic ossification, a prominent implant or a loose body within the joint can create a mechanical block. A hard end point, intermittent locking or pain at the end of the range can be clues.
Tendons, nerves and inflammation
Pain at the back of the elbow may arise from the olecranon bursa or triceps tendon, while anterior symptoms may involve the biceps. Inflammatory disease or joint infection can also cause painful restriction. Ulnar-nerve irritation more often causes numbness in the little and ring fingers, but it may coexist with post-traumatic stiffness.
How does an orthopaedic surgeon investigate the cause?
The examination compares both sides, measures flexion and extension, assesses forearm rotation and determines whether active motion, passive motion or both are restricted. Stability, strength, sensation and hand circulation are also checked, together with the shoulder and wrist when appropriate.
X-ray
X-ray is usually the first imaging test after trauma and when a bony cause is suspected. It may show fracture, dislocation, osteoarthritis, heterotopic ossification, loose fragments or abnormal implant position.
CT, MRI and ultrasound
CT shows bony obstacles in greater detail and can be useful for operative planning. MRI is used selectively when cartilage, ligaments or other soft tissues are important. Ultrasound can assess selected tendons, bursae, fluid collections and nerves, but it does not replace X-ray or CT when the problem is an intra-articular bony block.
How is loss of extension treated?
Treatment depends on the cause and how long the restriction has been present. After a recent injury, the damaged structure is protected first. Once the joint is stable and there is no contraindication, appropriately timed controlled movement can help reduce the risk of contracture. Forceful self-stretching through severe pain or abrupt manipulation should be avoided.
For chronic stiffness, physiotherapy and individually selected static-progressive or dynamic bracing may be used to increase motion gradually. A review in EFORT Open Reviews notes that improvement with bracing can continue over 6–12 months, so the absence of a rapid response does not automatically mean that surgery is required.
Surgery may be considered when established stiffness clearly limits function despite appropriately conducted non-operative treatment, or when a mechanical obstacle is present. Release can be arthroscopic or open; the choice depends on the location of the contracture, bony changes, previous surgery and the course of nearby nerves. A difference of only a few degrees without meaningful symptoms is not in itself an indication for surgery.
When is urgent assessment needed?
- visible deformity after injury or sudden loss of motion;
- severe pain with rapidly increasing swelling;
- a hand that becomes cold, pale or blue;
- increasing numbness or weakness;
- a hot, red joint with fever;
- a draining wound or possible open fracture;
- true locking that prevents even gentle movement of the joint.
The key point
Loss of elbow extension is a symptom, not a single diagnosis. After a recent injury, fracture or dislocation must be excluded; in chronic stiffness, soft-tissue contracture must be distinguished from a mechanical block. Only then can exercises, bracing or operative treatment be selected rationally.
More patient information: Orthopaedic Conditions and Symptoms and For Patients.
References
- Siemensma MF, van der Windt AE, van Es EM, Colaris JW, Eygendaal D. Management of the stiff elbow: a literature review. EFORT Open Rev. 2023;8(5):351–360. DOI: 10.1530/EOR-23-0039. PubMed.
- American Academy of Orthopaedic Surgeons. Osteoarthritis of the Elbow. OrthoInfo.
- Fan M, Xu F, Fei C et al. Post-traumatic elbow stiffness: etiology, risk factors and current treatments. Front Surg. 2025;12:1643326. DOI: 10.3389/fsurg.2025.1643326.
Content prepared by: Tomasz Poboży - orthopaedic surgeon.