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New Technique To Prevent Elbow Stiffness After Injuries

NEW YORK (Mar 10, 2014)

Patients who suffer an elbow injury often experience contractures and stiffness following the injury, resulting in loss of motion and difficulty performing daily activities. Now, a leading orthopedic surgeon has developed and is testing a new method to prevent contractures, or permanent shortening of muscles, tendons and/or ligaments, from occurring in the first place.

Melvin P. Rosenwasser, M.D.
Melvin P. Rosenwasser, M.D.

"Every orthopedic surgeon understands how difficult it is to maintain and facilitate the rehabilitation of elbow motion – that's a universality," said Melvin P. Rosenwasser, M.D., who has tested the use of Botox injections to treat contractures of the elbow. "A number of techniques have been used in the past to try to enhance elbow motion that have all been mechanical – physical therapy, various types of splints, both dynamic and static – and all intended to assist in the recovery of end range flexion and especially extension."

Typically, orthopedic surgeons treat elbow fractures, dislocations, or other trauma with surgery and then patients undergo a slew of exercise regimens to rehabilitate the elbow. Despite orthopedic surgeons and physical therapists best efforts to prevent post-traumatic elbow contractures, the condition often still occurs. Dr. Rosenwasser explained that when tissues or ligaments tear during an elbow injury or cartilage and bones are injured, there is a loss of elasticity in the elbow. "After treatment the anatomy was reassembled and the X-rays would look okay, but the patient still could not overcome the tissue sequellae of contracture and muscle shortening and spasm," he said. "And although patients work very hard and very diligently, they cannot straighten their arm. They go through weeks and months of therapy, and they wear custom braces with rubber bands and springs to try to stretch the contracted elbow. These are very uncomfortable and often ineffective. Sometimes the contracture requires a secondary surgery to excise the scar tissue. Even then, the outcome fails to restore the patient to the preinjury state."

Frustrated with these outcomes, Dr. Rosenwasser tried a different technique to reduce some of the biological factors that lead to contracture. "I decided to work on the muscles as they can go into spasm after trauma. The muscles are being tensed below your level of conscious thought," he explained.

Dr. Rosenwasser began testing the use of an intraoperative injection of botulinum toxin-A (Botox) into the muscles, or elbow flexors, that impede elbow extension. "The Botox needs to be injected soon after the injury has had its definitive treatment or surgery," he said. Preliminary results of Botox injections to treat elbow contractures have been very successful. "Patients regain their end range motion sooner and better. It's a wonderful adjunct to traditional therapies," said Dr. Rosenwasser.

According to Dr. Rosenwasser, patient acceptance is high for this approach because of the widespread awareness of Botox use in cosmetic procedures. "Getting a Botox injection isn't scary. You always want to know first, is it safe? And the answer is, yes, it's completely safe. And two, is it efficacious? And, yes, it is," he said.

Dr. Rosenwasser has presented the results of this technique at numerous professional societies. This has led many orthopedic surgeons wondering if Botox has general applicability for contracture in other joints, for example, the shoulder. "It may have many other indications but it would require similar clinical studies to demonstrate efficacy," noted Dr. Rosenwasser.

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