Elbow Stiffness & Heterotopic Ossification

Understanding Elbow Stiffness & Heterotopic Ossification

The elbow is especially prone to stiffness. After a fracture, dislocation or surgery, the joint capsule can thicken and tighten, scar tissue can form, and in some patients extra bone grows in the soft tissues around the joint, a condition called heterotopic ossification ^[1]. Arthritis and bone spurs can also block motion.

Most everyday activities need an arc of about 30 to 130 degrees of bending and straightening and about 50 degrees of turning the palm up and down in each direction ^[2]. When stiffness falls outside that range, simple tasks such as eating, washing your face or reaching a back pocket become difficult.

Early, guided motion after injury or surgery is the best way to prevent stiffness, and therapy with stretching and adjustable splints helps many patients in the first months ^[1]. When motion stays limited after the tissues have healed, surgery can release the tight capsule and remove scar tissue, bone spurs or heterotopic bone. Both arthroscopic and open releases improve motion and pain, with comparable overall results, so the approach is chosen for each elbow ^[3]. Medications given to prevent heterotopic bone have not proved effective after elbow trauma surgery in a randomized trial ^[4].

Causes & Risk Factors

• Elbow fractures and dislocations
• Prior elbow surgery
• Heterotopic ossification (extra bone forming around the joint)
• Elbow arthritis and bone spurs
• Burns or head injuries, which increase the risk of heterotopic bone

Symptoms

Common signs and symptoms of Elbow Stiffness include:

• Unable to fully straighten or bend the elbow
• Difficulty reaching the face, mouth or a back pocket
• Pain at the end of motion
• A hard block to motion
• Stiffness that has not improved with therapy

Treatment Options

Treatment for Elbow Stiffness depends on the severity of your condition and may include:

• Early guided motion after injury or surgery
• Physical therapy and stretching
• Static progressive or dynamic splints
• Arthroscopic capsular release and removal of bone spurs
• Open release and removal of heterotopic bone

References

1. King GJ, Faber KJ. Posttraumatic elbow stiffness. Orthop Clin North Am. 2000;31(1):129-43. doi.org/10.1016/s0030-5898(05)70133-4
2. Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am. 1981;63(6):872-7. pubmed.ncbi.nlm.nih.gov/7240327/
3. Khorram R, Ghayyad K, Vafadar R, et al. Surgical treatments of post-traumatic elbow stiffness: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2026;35(1):387-407. doi.org/10.1016/j.jse.2025.05.004
4. Atwan Y, Abdulla I, Grewal R, et al. Indomethacin for heterotopic ossification prophylaxis following surgical treatment of elbow trauma: a randomized controlled trial. J Shoulder Elbow Surg. 2023;32(6):1242-1248. doi.org/10.1016/j.jse.2023.02.119