Breaking The Pain-Stiffness Cycle-Supraclavicular Catheter Facilitated Rehabilitation Of Post-Surgical Elbow stiffness-A Retrospective Observational Study
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Background
Post-traumatic elbow stiffness is a recognised complication following orthopaedic trauma surgery, occurring in 10-15% of trauma patients sustaining injuries. Pain remains the primary barrier to physiotherapy compliance, with surgical arthrolysis carrying recurrence rates of up to 34%. The supraclavicular brachial plexus block, referred to as the ‘spinal of the arm’, provides anaesthesia and analgesia to the entire upper limb below the shoulder. A structured non-surgical approach combining continuous catheter analgesia with timed rehabilitation was identified as an unmet need in this patient group.
Methods
A single-centre retrospective observational study was conducted on data of patients treated for post-surgical upper limb stiffness between January 2022 and April 2026. Of 30 patients identified, 28 with elbow involvement formed the primary analysis group following exclusion of 2 patients with isolated wrist stiffness and complex regional pain syndrome. Ultrasound-guided supraclavicular brachial plexus catheters were inserted using the Contiplex system. Patients received 0.5% Bupivacaine (10-15ml) for initial blockade, followed by daily top-up doses of 0.2% Ropivacaine(20ml) given 30 minutes prior to structured physiotherapy and CPM sessions for up to 5 days. The primary outcome was change in arc of elbow motion in degrees, measured by the attending orthopaedic consultant using standard goniometry.
Results
Complete pre- and post-intervention data were available for all 28 patients. Mean pre-intervention arc of elbow motion was 39.1°(SD+/-23.2°), improving to 104.2°(SD+/-30.0°) post-intervention. Mean improvement was 65.1°(SD+/-30.6°; 95% CI 53.8° to 76.4°; range 10°-140°; paired t-test t=-11.27, p<0.0001). Mean catheter duration was 5.2 days (SD+/-1.3). Five patients (17.9%) experienced mechanical catheter complications-3 dislodgements, 1 kinking and 1 block failure-with no episodes of Local Anaesthetic Systemic toxicity, infection or neurological deficit.
Conclusion
Continuous supraclavicular brachial plexus catheter analgesia represents a promising, minimally invasive rehabilitation tool for post-surgical elbow stiffness — achieving statistically and clinically meaningful Range of Motion (ROM) improvement through targeted regional analgesia, without the need for surgical intervention. These findings support prospective evaluation of this protocol as a primary non-surgical rehabilitation strategy.
