Introduction to Stiffness of the Elbow, Wrist and Related Pathologies (ISAKOS Book, 2025)

Luigi A. Pederzini, MD, ITALY Toshiyasu Nakamura, MD, PhD, JAPAN Andrea Celli, MD, ITALY Gregory I. Bain, MBBS, FRACS (Ortho), FAOrthoA, PhD, AUSTRALIA

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Introduction

The 2025 publication Stiffness of the Elbow, Wrist and Related Pathologies³, (Fig. 1) released by ISAKOS in collaboration with Springer Nature, is a landmark contribution in the study of upper-limb function and pathology and follows the publication of other 3 books^1,2,4 on elbow and wrist disorders (Figs. 2, 3, and 4). Stiffness of the elbow and wrist continues to be one of the most difficult challenges for clinicians, combining the complexity of joint biomechanics with the disabling consequences of trauma, surgery, and/or degenerative disease. This volume, through nearly 400 pages of structured discussion, illustrations, and clinical experience, provides a comprehensive exploration of the mechanisms, diagnostic approaches, and treatment strategies that define the care of these conditions. The book is divided into two major sections: one addressing stiffness of the elbow and the other focusing on stiffness of the wrist. Within these sections, the editors have carefully curated chapters that progress from fundamental anatomy and pathophysiology to advanced operative techniques and postoperative care. This progression gives the text a logical narrative, ensuring that readers not only understand the basic principles but also acquire practical knowledge for clinical decision-making.

Elbow

The chapters dedicated to the elbow begin with an overview of the anatomical and biomechanical characteristics that predispose this joint to stiffness. The elbow is uniquely complex, integrating flexion-extension with pronation-supination, and its susceptibility to post-traumatic and post-surgical complications makes it a frequent site of functional limitation. The book explains how fibrosis of the capsule, formation of heterotopic ossification, contracture of periarticular muscles, and incongruity of the articular surfaces contribute to restricted motion. The pathophysiology is linked directly to clinical outcomes, with even small losses of range of motion profoundly altering daily activities. Subsequent chapters address diagnostic evaluation in detail. The authors emphasize the value of a structured clinical examination, measurement of active and passive motion, and careful analysis of functional demands in athletes and workers. Radiographic imaging, computed tomography (CT), and magnetic resonance imaging (MRI) are described not only as diagnostic tools but also as essential elements in preoperative planning. These chapters underscore the importance of distinguishing between soft-tissue and bony causes of stiffness, a fundamental step in selecting the most appropriate treatment pathway. The therapeutic section of the elbow part is particularly rich. Non-surgical strategies are presented with an emphasis on early mobilization, physiotherapy protocols, splinting techniques, and the judicious use of pharmacological adjuncts. The discussion clarifies when conservative care may be sufficient (e.g., in in patients with early contractures or contraindications for surgery) and when it risks being ineffective. This is followed by a comprehensive presentation of surgical approaches, ranging from open capsular releases to minimally invasive arthroscopic and endoscopic procedures. The book explains in detail how to address anterior and posterior capsular contracture, remove osteophytes, release adhesions, and manage heterotopic ossification. Special attention is paid to preoperative planning, with advances such as three-dimensional printing allowing surgeons to model patient-specific anatomy and anticipate intraoperative challenges. Case-based chapters illustrate how these techniques are applied in both straightforward and complex scenarios, such as malunions, failed previous surgeries, or combined ligamentous injuries. Rehabilitation following elbow surgery is given its own emphasis. The text illustrates protocols of early passive and active mobilization, the role of continuous passive motion devices, and strategies to prevent recurrence of stiffness. It highlights the importance of collaboration between surgeon, physiotherapist, and patient, describing how compliance and structured follow-up can determine the difference between success and failure.

Wrist

The section on the wrist mirrors this structure but adapts it to the specificities of carpal anatomy and biomechanics. It begins by describing the etiologies of wrist stiffness, which often follow intra-articular fractures, ligament injuries, or degenerative changes. The complexity of the carpal bones and their ligamentous connections makes stiffness not only a matter of range of motion but also of stability and pain, and the chapters carefully describe how to integrate these dimensions in clinical assessment. Diagnostic approaches again combine careful physical examination with radiographs, CT, and MRI, providing a complete view of bone alignment, cartilage damage, and soft-tissue contracture. In terms of treatment, the wrist section explores both non-surgical and surgical strategies. Conservative management through immobilization protocols, splinting, and physiotherapy is described in depth, clarifying its indications and limitations. Surgical approaches include both arthroscopic and open techniques. The arthroscopic chapters are particularly detailed, offering descriptions of capsular release, synovectomy, debridement, and hardware removal. In more advanced cases, where motion cannot be restored, partial or total wrist arthroplasty and arthrodesis are discussed, with attention to the delicate balance between stability, mobility, and pain relief. Once again, the role of postoperative rehabilitation is emphasized, with strategies aimed at regaining not only movement but also grip strength and proprioception.

Related Topics

Further chapters in the book broaden the perspective to include related topics that influence both elbow and wrist stiffness. Pediatric cases are discussed separately, recognizing that growth, remodeling potential, and long-term functional outcomes create unique challenges in children and adolescents. Systemic diseases, such as rheumatoid arthritis or neurological conditions, are addressed as additional contributors to stiffness, requiring specific diagnostic and therapeutic adaptations. The volume also dedicates space to complications, offering guidance on how to recognize and manage persistent stiffness, instability, infection, and neurovascular injury after treatment. A particularly forward-looking section examines emerging technologies and innovative approaches. The use of three-dimensional printing for surgical planning, navigation-assisted arthroscopy, and biologic therapies are described as fields that may transform the management of stiffness in the near future. These chapters highlight not only technical advances but also the ethical and logistical questions surrounding their adoption, such as accessibility, cost, and the need for specialized training.

What makes this volume distinctive is its ability to integrate theoretical knowledge with practical application. Each chapter closes with clinical insights that help the reader understand the nuances of decision-making. The text conveys the message that stiffness is not a condition that can be treated through a single intervention but rather is a complex problem that requires a multidisciplinary approach. It stresses that the surgical act must be complemented by rehabilitation, patient education, and long-term monitoring, reminding the reader that success is measured not only by motion regained but also by the patient’s return to function and quality of life.

The richness of the book also lies in its illustrations. Over 200 full-color images, intraoperative photographs, and radiographic examples make the content tangible and directly applicable. These visual aids are complemented by case studies, which demonstrate how principles are translated into practice across a variety of clinical scenarios. The inclusion of both common cases and rare, complex situations makes the book valuable to a wide audience, from trainees seeking foundational knowledge to experienced surgeons confronted with challenging cases.

Future Perspectives

Beyond its clinical value, the volume points toward areas of ongoing research and future development. It calls for standardization of assessment methods, beyond simple range-of-motion measurement, to include functional scoring systems and patient-reported outcomes. It highlights the need for comparative studies that evaluate conservative and surgical interventions in different populations and settings. It raises questions about long-term prognosis, particularly in younger patients, and about the durability of newer technologies such as arthroplasty or biologic augmentation. In this sense, the book is not only a repository of current knowledge but also a catalyst for innovation and scientific collaboration.

For ISAKOS members, this text resonates deeply with the society’s mission to advance education, research, and clinical practice in orthopedic sports medicine and arthroscopy. The book’s structure, which moves seamlessly from basic science to clinical application, mirrors the ISAKOS commitment to integrating knowledge across disciplines. Its international authorship reflects the global collaboration that characterizes ISAKOS meetings and publications. Most importantly, its emphasis on practical, evidence-based strategies aligns with the society’s goal of providing its members with resources that directly enhance patient care.

Conclusion

In conclusion, Stiffness of the Elbow, Wrist and Related Pathologies is more than a textbook; it is a comprehensive guide that captures the current state of the art while pointing toward future directions in the management of one of the most disabling problems of the upper limb. Its detailed exploration of anatomy, diagnosis, conservative and surgical management, rehabilitation, complications, and innovations ensures that it will serve as a lasting reference for years to come. For orthopedic surgeons, sports medicine physicians, and rehabilitation professionals, this book offers not only knowledge but also a framework for thinking critically and acting effectively in the face of stiffness. It stands as an essential resource for any clinician striving to restore motion, function, and quality of life to patients affected by these complex conditions.

Fig. 1. Stiffness of the Elbow, Wrist and Related Pathologies (2025).

Fig. 2. Arthroscopy and Endoscopy of the Elbow, Wrist and Hand (2022).

Fig. 3. Surgical Techniques for Trauma and Sports Related Injuries of the Elbow (2020).

Fig. 4. Elbow Arthroscopy (2013).

References

1. Bain Gregory , Eygendaal Denise, van Riet Roger P. (eds) Surgical Techniques for Trauma and Sports Related Injuries of the Elbow Springer Nature, 2019. ISBN-13‏ : ‎ 978-3662589311
2. Bhatia Deepak N. , Bain Gregory I. , Poehling Gary G. , Graves Benjamin R. (eds). Arthroscopy and Endoscopy of the Elbow, Wrist and Hand Springer Nature, 2022 DOI https://doi.org/10.1007/978-3-030-79423-1
3. Pederzini L, Nakamura T, Celli A, Bain G (eds). Stiffness of the Elbow, Wrist and Related Pathologies. Springer Nature, 2025. DOI https://doi.org/10.1007/978-3-031-81381-8
4. Pederzini Luigi Adriano, Bain Gregory, Safran Marc R. (eds) Elbow Arthroscopy Springer 2013 ISBN‏ : ‎ 978-3642381027

Please note: ISAKOS Newsletter Current Perspectives are not peer-reviewed articles. For peer-reviewed articles, please visit the Journal of ISAKOS at jisakos.com.