Article Document Academic Article Information Content Entity Continuant Continuant Journal Article Entity Entity Generically Dependent Continuant 2025-05-10T17:12:23 RDF description of Posterior elbow capsulotomy and triceps lengthening for elbow extension contracture in children with arthrogryposis multiplex congenita - http://repository.healthpartners.com/individual/document-rn38421 Orthopedics 10.2106/jbjs.St.19.00030 1 document-rn38421 10 Pediatrics Surgery 41000 JBJS essential surgical techniques Posterior elbow capsulotomy and triceps lengthening for elbow extension contracture in children with arthrogryposis multiplex congenita public 23690 <p>Posterior elbow capsulotomy plus triceps lengthening facilitates passive elbow flexion in children with arthrogryposis multiplex congenita, allowing independent function for activities of daily living, such as feeding and self-care of the face and hair. <br>DESCRIPTION: The posterior aspect of the distal end of the humerus and the olecranon are identified by palpation and exposed via a curvilinear incision over the posterior aspect of the elbow. Identifying the osseous landmarks can be challenging in some patients. The ulnar nerve is identified and protected. The triceps tendon is isolated, and z-lengthening is performed. Next, the posterior elbow capsule is incised proximal to the tip of the olecranon to expose the joint surface, and the arthrotomy is continued incrementally along the medial and lateral capsule until elbow flexion increases by � 40°, or past 90° (maximum, 120°), with contact between the lengthened ends of the triceps tendon for repair. The triceps tendon is then repaired in the elongated position. After the wound is closed, the elbow is placed in flexion and immobilized in a cast. <br>ALTERNATIVES: Alternative treatments include passive stretching exercises to increase elbow flexion. <br>RATIONALE: Elbow extension contractures result in substantial limitations in the activities of daily living for children with arthrogryposis multiplex congenita. Those who fail to attain at least 90° of elbow flexion with passive stretching in the first year of life benefit from posterior elbow release and triceps lengthening. In addition, children with <30° of passive elbow flexion are at risk of developing valgus instability of the elbow from passive flexion exercises because the axis of rotation of the elbow is difficult to detect. Once passive elbow flexion is attained, such children may be candidates for tendon transfers allowing active elbow flexion.<p> Arm 2025-01-31T22:52:05.028-06:00