Were you told to just live with a stiff elbow, or that you need open surgery to fix it? There is another option.
A stiff or tight elbow is not just an inconvenience. For a UFC fighter who can't fully extend their arm, a baseball pitcher who can't straighten their elbow, a football lineman who can't lock out their arm, or a laborer who can't reach overhead — it is a career and quality-of-life problem that demands a real solution.
Dr. Raffy Mirzayan has performed more than 1,000 elbow arthroscopic procedures over 25 years, with zero nerve or vascular injuries in his personal series. He treats elbow stiffness and contracture in some of the most demanding athletes and workers imaginable — and he does it with techniques that most surgeons in the country cannot offer arthroscopically.
Call (310) 746-5918 to schedule a consultation.
Why Does the Elbow Get Stiff?
The elbow is one of the joints most prone to stiffness after injury, surgery, or prolonged immobilization. Unlike the shoulder or knee, the elbow has very little tolerance for swelling, scar tissue, or capsular tightening — even small amounts of inflammation can result in significant loss of motion.
The most common causes Dr. Mirzayan treats include:
Athletic injury and overuse — MMA and combat sports athletes place enormous compressive and torsional loads on the elbow. Repeated impacts, joint trauma, and chronic inflammation lead to scar tissue formation, osteophyte (bone spur) development, and progressive loss of motion. Football players develop posterior impingement from hyperextension forces. Baseball players develop flexion contractures and valgus extension overload from years of throwing.
Post-traumatic stiffness — Elbow fractures, dislocations, and the hardware used to fix them (ORIF — open reduction internal fixation) are among the most common causes of severe elbow stiffness. Scar tissue forms around the implants and within the joint capsule, dramatically restricting motion. These cases are among the most challenging to treat and require a surgeon with deep elbow expertise.
Post-surgical stiffness — Any prior elbow surgery can result in scar tissue formation and capsular contracture. Patients who have had Tommy John reconstruction, OCD capitellum surgery, or prior arthroscopy may develop stiffness that requires a secondary release procedure.
Heavy labor — Construction workers, mechanics, and other laborers who perform repetitive heavy upper extremity tasks develop degenerative changes, bone spur formation, and joint tightening that progressively limits function.
When Does a Stiff Elbow Need Surgery?
Not every stiff elbow requires surgery. Dr. Mirzayan always attempts non-surgical treatment first — physical therapy, a structured stretching program, and dynamic splinting — for patients whose stiffness is primarily due to soft tissue tightness. Given several months of consistent effort, many patients recover meaningful motion without an operation.
However, there are situations where no amount of physical therapy or stretching will restore motion, and surgery is the only path forward:
Bone spurs that are physically blocking motion. When osteophytes have grown large enough to mechanically impinge on one another — in the posterior compartment during extension, or in the anterior compartment during flexion — the joint is blocked by bone. Stretching cannot move bone. Surgery is required to remove the impinging spurs and release the capsule.
Flexion contracture greater than 30 degrees. When a patient cannot straighten their elbow past 30 degrees of flexion, this level of contracture almost always has a structural component — thickened anterior capsule, anterior osteophytes, or both — that will not respond to conservative measures.
Inability to flex past 100 degrees. When a patient cannot bend their elbow past 100 degrees, they typically cannot reach their mouth, touch their head or hair, or bring their hand to their shoulder. This level of flexion loss significantly impairs activities of daily living. Restoring flexion requires releasing the posterior and posteromedial capsule — a technically demanding step that most surgeons perform through an open incision.
Dr. Mirzayan performs this release arthroscopically.
What Makes Dr. Mirzayan's Approach Different
The posteromedial capsule release — done arthroscopically.
Restoring full elbow flexion requires releasing the posterior and posteromedial joint capsule. This is technically one of the most demanding steps in elbow surgery because the posteromedial capsule lies in direct proximity to the ulnar nerve. The risk of nerve injury in this area is real — and it is the reason most surgeons convert to an open approach for this portion of the procedure, making a larger incision to directly visualize and protect the nerve.
Dr. Mirzayan performs this release entirely arthroscopically. His ability to safely work in this anatomically complex region through small portals — without a single nerve injury in more than 1,000 elbow arthroscopies — reflects a level of elbow-specific expertise that is genuinely rare. Patients who have been told they need open surgery for their elbow stiffness should seek a second opinion.
The Arthrex NanoNeedle™ Scope 2.0.
Dr. Mirzayan uses the NanoNeedle Scope 2.0 — the same technology used in Tarik Skubal's, a two time Cy Young Award winner, elbow procedure — for appropriate cases of elbow contracture release. At 1.9 millimeters in diameter and requiring 65% less fluid than a standard arthroscope, the NanoNeedle Scope causes dramatically less tissue disruption, less post-operative swelling, and a faster return to rehabilitation. For a procedure where controlling post-operative inflammation is critical to preventing recurrent stiffness, this matters enormously.
Amniotic tissue to prevent scar reformation.
Dr. Mirzayan applies amniotic tissue at the time of surgery to the released capsule and joint surfaces to actively resist scar tissue reformation. This is not a step he added because it sounds appealing — it is a technique grounded in his own published research. Dr. Mirzayan has authored three peer-reviewed publications on the use of human amniotic membrane in orthopedic surgery, including a review paper in The American Journal of Orthopedics, a clinical outcomes study in the Archives of Bone and Joint Surgery demonstrating that amniotic membrane wrapping reduced the recurrence of ulnar nerve symptoms by 24-fold compared to controls, and a case series published in JBJS Case Connector demonstrating that amniotic membrane wrapping of the ulnar nerve during elbow surgery completely prevented scar formation around the nerve — confirmed on histologic analysis. These are not theoretical benefits. Dr. Mirzayan has studied this tissue, published on it, and applies it routinely because the evidence supports it.
Zero nerve or vascular injuries in over 1,000 elbow arthroscopies.
Dr. Mirzayan co-authored one of the largest elbow arthroscopy complication studies in the medical literature, published in Arthroscopy: The Journal of Arthroscopic and Related Surgery, analyzing 560 consecutive elbow arthroscopies across 42 surgeons. The overall nerve injury rate in that broader group was 3.5% — consistent with published literature reporting rates as high as 10%. In Dr. Mirzayan's own personal series of more than 1,000 elbow arthroscopies, he has not had a single nerve or vascular injury. In a procedure where the ulnar nerve is at risk, that record is the most meaningful safety credential a surgeon can offer.
The Procedure
Arthroscopic elbow contracture release is performed under general anesthesia as an outpatient procedure — patients go home the same day.
Through small portals around the elbow, Dr. Mirzayan uses the arthroscope and specialized instruments to systematically address the sources of stiffness:
- Removal of scar tissue from the anterior and posterior compartments
- Resection of anterior osteophytes blocking extension
- Resection of posterior osteophytes blocking extension in the olecranon fossa
- Release of the anterior capsule to restore extension
- Arthroscopic posteromedial capsule release to restore flexion, when indicated
- Loose body removal if fragments are present
- Application of amniotic tissue to released surfaces to minimize scar reformation
The NanoNeedle Scope 2.0 is used when appropriate for its superior access to tight joint spaces and reduced tissue disruption.
Recovery and Return to Sport
Recovery from elbow contracture release is a commitment — and patients who understand this going in have the best outcomes.
Motion begins immediately. Physical therapy starts within days of surgery, and aggressive range-of-motion work is the cornerstone of recovery. The motion gained in the operating room must be maintained and built upon through consistent stretching and therapy — if rehabilitation is neglected, scar tissue can reform and motion can be lost again.
Most athletes return to sport at approximately three months, though the exact timeline depends on the sport, the position played, and the degree of preoperative contracture. A UFC fighter returning to full contact, a baseball pitcher returning to throwing, and a football lineman returning to blocking all have different functional demands and different return-to-sport milestones. Dr. Mirzayan and his team will work with you and your athletic trainer or coaching staff to build a return-to-sport program specific to your needs.
The physical therapy and stretching program does not end at three months. Maintaining elbow motion is an ongoing commitment, particularly in the first six to twelve months after surgery.
Athletes and Out-of-State Patients
Elbow stiffness in high-level athletes — particularly combat sports athletes, football players, and baseball players — requires a surgeon who understands the specific demands of each sport and the consequences of inadequate motion recovery. Dr. Mirzayan regularly treats athletes and patients traveling from across the country, including Texas, Florida, Arizona, Georgia, and Nevada.
He is an out-of-network provider, but most patients with commercial insurance have out-of-network benefits that significantly reduce out-of-pocket costs. Virtual consultations are available so you can meet Dr. Mirzayan, review your imaging, and determine the right path forward before committing to travel.
Call (310) 746-5918 to schedule a consultation or ask about virtual visits.
Frequently Asked Questions
How do I know if I need surgery or if PT will work?
If your stiffness is primarily due to soft tissue tightness and you do not have large bone spurs blocking motion, a structured course of physical therapy and stretching is always attempted first. If you have significant bone spurs mechanically blocking the joint, or if you have a flexion contracture greater than 30 degrees or cannot flex past 100 degrees, surgery is almost certainly necessary. Dr. Mirzayan will review your imaging and examination findings and give you a direct, honest recommendation.
What is a flexion contracture and how do I know if I have one?
A flexion contracture means you cannot fully straighten your elbow. If you cannot extend your elbow to within 30 degrees of fully straight, that is a significant contracture that is unlikely to resolve with stretching alone.
What if I can't bend my elbow enough to reach my mouth?
Inability to bend past approximately 100 degrees means you cannot bring your hand to your face, touch your head, or reach your shoulder. This level of flexion loss requires posteromedial capsule release — a step most surgeons perform through an open incision. Dr. Mirzayan performs this arthroscopically.
What is amniotic tissue and why do you use it?
Amniotic tissue is derived from the innermost layer of the placenta and has well-documented anti-inflammatory and anti-fibrotic properties and has been used in medical treatments for over 100 years. Dr. Mirzayan applies it to released joint surfaces at the time of surgery to create a biological environment that resists scar tissue reformation — protecting the motion gained during the procedure.
What is the risk of nerve injury?
Nerve injury is the most cited risk of elbow arthroscopy, with published rates ranging from 0.5% to over 10% depending on the series. In Dr. Mirzayan's personal series of more than 1,000 elbow arthroscopies — including posteromedial capsule releases performed in close proximity to the ulnar nerve — he has not had a single nerve or vascular injury.
Will my stiffness come back after surgery?
It can, if rehabilitation is not pursued diligently. The motion gained in surgery must be maintained through aggressive physical therapy and stretching. Patients who commit to their rehabilitation program have durable results. The use of amniotic tissue at the time of surgery also helps reduce the biological tendency for scar reformation.
Do you use the NanoNeedle Scope for this procedure?
Yes, when appropriate. The NanoNeedle Scope 2.0 — the same technology used in Tarik Skubal's elbow procedure — provides superior access to the tight spaces within a contracted elbow joint, causes less tissue disruption, and reduces post-operative swelling. Less post-operative swelling means earlier motion and better rehabilitation outcomes.
Do you see out-of-state patients for this procedure?
Yes. Dr. Mirzayan regularly treats patients traveling from Texas, Florida, Arizona, Georgia, Nevada, and beyond. Virtual consultations are available. Call (310) 746-5918 for more information about out-of-state care and out-of-network insurance benefits.
Dr. Raffy Mirzayan is a double-board certified orthopedic sports medicine surgeon at DOCS Health, 8436 W 3rd St #800, Los Angeles, CA 90048. To schedule a consultation, call (310) 746-5918 or visit raffymirzayan.com.
