The elbow is a complex hinge joint designed for two primary movements: bending the arm toward the shoulder, known as flexion, and straightening the arm, called extension. A healthy elbow typically allows for a full range of motion from a straight zero degrees of extension to approximately 140 to 150 degrees of flexion. The ability to perform most daily activities requires a functional arc of motion. When you cannot bend your elbow all the way or straighten it fully, it indicates a restriction that can stem from a variety of underlying issues, ranging from acute injury to progressive wear and tear.
Sudden Limitations from Acute Trauma
An immediate, sharp loss of elbow movement often signals a significant structural problem resulting from a specific incident, such as a fall or direct blow. Fractures of the bones that form the elbow joint—the distal humerus, radial head, or olecranon—can physically block movement. The displaced fragments of bone create a mechanical obstruction, preventing the joint surfaces from gliding smoothly into full flexion or extension.
A complete elbow dislocation, where the bones are forced out of alignment, instantly results in an inability to move the arm normally and is accompanied by visible deformity and intense pain. Severe ligamentous injury, or a sprain, can also lead to a sudden limitation because the associated swelling and pain cause muscle spasm that restricts the joint’s movement.
Gradual Restriction from Chronic Conditions
In contrast to sudden injury, some limitations develop slowly over months or years due to degenerative changes within the joint. Osteoarthritis, a common form of wear-and-tear arthritis, causes the protective cartilage on the bone ends to break down. This leads to bone-on-bone friction and the formation of osteophytes, or bone spurs, particularly on the coronoid and olecranon processes.
These bone spurs progressively reduce the available joint space, acting as bony blocks that physically stop the arm from achieving full flexion or extension. Rheumatoid arthritis, an inflammatory autoimmune condition, can also cause a gradual restriction by damaging the joint lining and capsule. This chronic inflammation leads to joint destruction and eventual stiffening, which limits the total capacity for movement. A loose body, which is a fragment of bone or cartilage floating within the joint fluid, can also intermittently catch in the joint space, causing a sudden, painful block.
Stiffness Following Healing and Immobilization
A distinct cause of movement restriction is the body’s response to healing after an injury or surgery, particularly following a period of immobilization. Prolonged lack of movement allows the soft tissues around the joint, such as the joint capsule and ligaments, to shorten and thicken. This process is known as capsular contracture, where the formation of dense scar tissue severely limits the joint’s ability to stretch and glide through its full arc.
Another complication, heterotopic ossification, involves the abnormal growth of mature bone within the soft tissues surrounding the elbow, such as the muscles and tendons. This new, misplaced bone acts as an extra-articular block, fundamentally restricting the mechanical movement of the joint. Post-traumatic arthritis, a form of osteoarthritis that develops after a severe fracture or dislocation, may also contribute to this delayed stiffness.
Determining the Severity and Seeking Medical Advice
It is important to seek professional medical advice if your elbow limitation is accompanied by significant deformity, a complete inability to use the arm, or a sudden loss of sensation in your forearm or hand. These signs may indicate nerve or blood vessel damage that requires immediate attention. For less urgent stiffness, a healthcare provider will first perform a physical examination to measure both active range of motion (how far you can move it yourself) and passive range of motion (how far they can move it for you).
Imaging studies are routinely used to determine the underlying cause of the restriction. X-rays are typically the first step, providing clear images of bone structures to identify fractures, malunion, or the presence of bone spurs. A computed tomography (CT) scan or magnetic resonance imaging (MRI) may be ordered to better visualize soft tissue damage, such as capsular thickening, scar tissue, or loose bodies not visible on a standard X-ray.
Management and Restoration of Elbow Mobility
Non-Surgical Treatment
The primary approach to restoring elbow mobility is non-surgical, centered on a consistent program of physical therapy. Physical therapists utilize stretching, joint mobilization techniques, and strengthening exercises to gently increase the range of motion. The goal is to stretch the contracted soft tissues and strengthen the muscles that control the joint, like the biceps and triceps. Anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be recommended to manage pain and reduce inflammation during the rehabilitation process. In some cases, dynamic or static splinting is used to apply a prolonged, low-load stretch to the joint capsule over several hours a day. This sustained tension helps remodel the scar tissue and gradually increase the resting length of the soft tissues.
Surgical Options
If conservative treatments fail to achieve a functional range of motion, surgical intervention may be considered. Arthroscopic surgery, a minimally invasive technique, allows a surgeon to remove physical impediments like bone spurs and loose bodies. It can also be used to perform a capsular release to cut thickened scar tissue. For patients with severe arthritis or complex fractures, a more involved surgery, such as total elbow joint reconstruction, may be necessary to restore the mechanical function of the joint. Following any surgical procedure, an intensive and dedicated physical therapy program is immediately initiated to prevent the stiffness from returning.