An 18-year-old woman with a one-year history of a severely stiff right elbow fixed at a 90-degree angle was successfully managed using a combination of manual release, minimally invasive needle-knife surgery, and internal and external herbal therapy.

Case ID: CHC-0055

Case Summary

This case describes an 18-year-old woman who presented with a one-year history of progressive right elbow stiffness without any obvious traumatic trigger. Her elbow had become rigidly fixed at a 90-degree angle. The original report documented a conventional diagnosis of right elbow joint stiffness and a TCM assessment of Impediment Syndrome (Bi Syndrome) driven by Blood Stasis and Sinew Impediment. She was managed through a highly integrative approach utilizing “Zhao’s plucking and swaying” manual release combined with a needle-knife joint capsule release under anesthesia, followed immediately by internal Kidney-tonifying herbs and external sinew-relaxing herbal soaks.

Patient Presentation

• Patient: 18-year-old female (Surname: Li).
• Main Complaint: Adverse mobility and stiffness of the right elbow joint for 1 year, progressively worsening.
• History: The patient sought consultation on August 7, 2023. One year prior, without any apparent cause, she developed restricted movement in her right elbow. This was not accompanied by neck pain, radiating arm pain, or hand numbness. She had sought previous examinations and treatments at other hospitals (details unknown) with poor results. The stiffness progressively worsened until her joint was locked, prompting her admission for further specialized treatment. She was otherwise healthy with normal appetite, sleep, and bowel/urinary function.

Examination and Diagnosis

• Physical Exam: The right elbow joint’s outward appearance was relatively normal, but the joint was rigidly fixed at 90°.
• Imaging (X-ray): Showed localized cortical thickening at the anterior margin of the lower right humerus with slight narrowing of the corresponding medullary cavity. Multiple dense shadows were seen in the anterior soft tissue. The right elbow joint’s correspondence remained normal.
• Conventional Diagnosis: Right elbow joint stiffness.
• TCM Tongue and Pulse: The tongue was pale red with a thin, white coating. The pulse was stringy and fine (脉弦细).

TCM Assessment

The original practitioner interpreted the presentation as Impediment Syndrome driven by Blood Stasis and Sinew Impediment (痹证 – 血瘀筋痹证).

According to the holistic principles of yin and yang Chinese Medicine joint stiffness is frequently caused by a combination of Qi and Blood stagnation, meridian blockage, and the resulting malnourishment of the sinews and bones. In this young patient, chronic localized blood stasis had severely trapped the meridians around the elbow. Over the course of a year, this stagnation caused the local sinews (tendons and ligaments) to become malnourished, resulting in severe contracture and physical adhesions (the “sinew nodes” or 筋结). The stringy and fine pulse objectively confirmed this combination of localized structural tension (stringy) and underlying blood/fluid insufficiency failing to nourish the joint (fine).

Treatment Approach

The primary treatment principle was to relax the sinews and unblock the impediment (舒筋通痹). The strategy required a multi-pronged approach: mechanically breaking the physical adhesions around the joint capsule, utilizing internal herbs to nourish the Kidneys and blood to repair the damaged tissues, and applying external herbal heat to aggressively dissolve the localized stasis.

Interventions and Herbal Formulas

• Needle-Knife and Manual Joint Release (Under Anesthesia):
  • Under brachial plexus anesthesia, the practitioner applied “Zhao’s plucking and swaying release” (招氏弹拨摇摆松解). The practitioner used their thumb to palpate the stiff sinew nodes, plucking them up, down, left, and right until the tissue softened. Gentle traction and swaying were applied until the joint loosened.
  • Following this, a 1cm incision was made at the anterolateral aspect of the right humeral lateral epicondyle. A needle-knife (针刀) was utilized to precisely cut and release the contracted elbow joint capsule.
  • Manual flexion and extension were applied again until the elbow could achieve near 0° extension and 150° flexion. A plaster splint was applied in the extended position (removed 3 days later).
• Internal Herbal Formula (August 7, 2023): A 10-herb decoction (Yishen Shujin Fang) to internally nourish the root and relax the sinews.
  • Nourishing Kidneys and Strengthening Sinews: Yan Du Zhong (Salt-prepared Eucommia, 15g), Tu Si Zi (Dodder Seed, 15g), Sang Ji Sheng (Taxillus, 15g), and Niu Xi (Achyranthes, 15g) form the core to deeply nourish the Kidney and Liver, which govern the bones and sinews, respectively.
  • Moving Blood and Unblocking Collaterals: Chuan Xiong (10g), Shen Jin Cao (Lycopodium, 10g), and Ji Xue Teng (Spatholobus, 10g) forcefully move blood, unblock the meridians, and relax the spasmodic sinews.
  • Expelling Dampness: Fu Ling (Poria, 15g) and Bai Zhi (Angelica Dahurica, 15g) drain dampness and stop pain. Zhi Gan Cao (5g) harmonizes.
  • Administration: 5 doses taken during the hospital stay; continued for 1 week post-discharge.
• External Herbal Wash (Shujin Huoluo Fang): Prescribed upon discharge to be used as a hot soak.
  • Contains 16 strong herbs including Xi Xin (20g), Hai Feng Teng (50g), Kuan Jin Teng (50g), Tou Gu Cao (20g), Wei Ling Xian (20g), and Bing Pian (30g).
  • Usage: Boiled in 3000ml of water down to 2500ml. The patient soaked and washed the right elbow twice daily for one month to use the combined power of heat and medicine to penetrate the joint, dissolve residual adhesions, and maintain the new range of motion.

Follow-Up

• Discharge (Day 5 Post-Op): The patient’s right elbow had moderate swelling but only mild tenderness. The active range of motion was dramatically improved to 5°–135°. Blood circulation and sensation in the distal limb were completely normal.
• One-Month Follow-Up: After strictly following the internal herbal regimen, the external daily soaks, and active rehabilitation exercises, the right elbow swelling and pain had completely disappeared. The joint’s flexion, extension, and rotation had basically returned to normal (Flexion 140°, Extension 0°, Pronation/Supination 85°).

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the aggressive yet tissue-sparing resolution of a severe, year-long joint contracture. When a joint is locked at 90 degrees for a year, severe physical adhesions form in the capsule and surrounding muscles.

Standard physical therapy is often too painful and ineffective, while open orthopedic surgery carries a heavy recovery burden. The practitioner brilliantly combined modern anesthesia with a specialized needle-knife to sever the deepest capsular adhesions through a tiny 1cm incision. More importantly, TCM recognizes that mechanical release is only half the battle; if the joint isn’t nourished with blood post-surgery, it will simply scar and freeze again. By mandating a month of intense external herbal heat soaks and internal Kidney-nourishing herbs (Yishen Shujin Fang), the practitioner ensured the newly separated tissues were flooded with fresh blood, resulting in a complete structural and functional cure.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine / Guangdong Provincial Administration of Traditional Chinese Medicine Original title: 【以案说医】招仕富：舒筋通痹法治疗右肘关节僵硬案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: September 8, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation