Dr Doron Sher is an orthopaedic surgeon in private practice in Sydney , and a VMO at Concord Repatriation General Hospital , Sydney , NSW .

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History MIKE , a 55-year-old right-handed painter , presents with an aching pain in the right elbow and increasing difficulty bending the elbow .

There has been no specific injury that he can recall , but on reflection he has noticed that he has been increasingly unable to fully straighten out his elbow over the past few years . Up until now , this has not interfered with his work or his occasional social tennis games .

He has presented now as it is beginning to interfere with activities of daily living , specifically he is intermittently having difficulty shaving due to the inability to bend his elbow sufficiently . On further questioning he denies any catching or locking of the joint .

Examination On examination of his elbow Mike is found to have 40-110 degrees of flexion with normal forearm rotation .

He has normal power and hand sensation , confirming that the ulnar nerve is not irritable at the elbow . On passive elbow flexion and extension , he experiences a pinching pain in the joint at the ends of his range of motion .

Investigation He is sent for X-rays of the joint . These show osteophyte formation at the tip of the olecranon and the coronoid , and on the humerus .

Mike is informed that he is developing some

degenerative changes within the elbow likely related to his work as a painter .

Management Mike is initially prescribed NSAIDs , which provide some initial relief of his symptoms . Physiotherapy is not indicated for this condition and tends to further irritate the joint .

The NSAIDs help for a few months , but Mike presents again with worsening symptoms of pain and stiffness in the elbow .

This is now causing some difficulty in his work as a painter . Mike is referred to an elbow specialist who arranges a fine-cut CT scan of the elbow with 3D reconstructions . MRI scanning is not usually needed in this setting to make a treatment decision .

The CT scan confirms osteophytes , some degenerative changes and in addition , finds some small loose bodies within the elbow .

Since Mike is now having difficulty at work , and with his activities of daily living , the elbow specialist offers him surgical management — an arthroscopic stiff elbow release . Mike undergoes the procedure and after a one-day stay in hospital , returns home . Within six weeks of the arthroscopic stiff elbow release , he is able to return to work and can conduct all normal activities . He is able to return to tennis a few weeks later .

Discussion The arthroscopic stiff elbow release operation is performed under a general anaesthetic and

MRI SCANNING IS NOT USUALLY NEEDED ... TO MAKE A TREATMENT DECISION .