Post-traumatic Elbow Contracture Characterization and Physical Therapy-based Treatment Strategies in a Preclinical Model
Date of Award
Doctor of Philosophy (PhD)
The elbow is the most commonly dislocated joint in the pediatric population and second most common in adults. As one of the most congruous joints in the body, slight changes in biomechanics due to injury can lead to drastic reductions in range of motion causing potential quality of life issues. Post-traumatic joint contracture occurs in 12% of patients following elbow dislocation or fracture, and it is characterized by a loss in ROM, joint stiffness, and pain. Preventing joint contracture and functional deficits from occurring is one of the primary goals when managing these injuries. A rat model of joint contracture following simple elbow dislocation was developed to replicate this debilitating clinical condition. Previous studies quantified the temporal elbow ROM losses in both flexion-extension and pronation-supination and elucidated tissue-specific contributors to motion loss. Additionally, previous work examined periarticular histological changes at different stages of injury/healing. Building upon this foundation, the work presented herein quantified additional clinically relevant outcomes in this validated animal model including joint functional changes and sex-based comparisons. In addition, physical therapy-based treatment strategies were evaluated to determine their effectiveness in preventing or improving outcomes that accompany this debilitating condition. Functional measures of grip strength and gait showed long-term deficits with limited recovery, male and female animals demonstrated similarly debilitating outcomes in joint function, mechanics, and morphology, and the timing of active joint use following injury was determined to have a direct impact on elbow function and mechanics. This work significantly advances our understanding of post-traumatic elbow contracture. Ultimately, the work presented here, as well as future proposed studies, can help inform clinical treatment strategies necessary to prevent elbow PTJC. While a specific traumatic elbow injury is investigated here, principles from this work could extend to different elbow injury patterns as well as other joints susceptible to PTJC.