Abnormal Patterns of Biceps and Triceps Co-Contraction Following Elbow Surgery May Result in Elbow Stiffness

Document Type : RESEARCH PAPER


1 Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, PA, USA

2 2 Rothman Orthopedic Institute, Adventhealth, Orlando, FL, USA 3 University of Central Florida, Orlando, FL, USA

3 Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY, USA


Objectives: This study examines the pattern of muscular contraction and the intensity of this contraction of the biceps and triceps following elbow surgery. Methods: We performed a prospective electromyographic study of 16 patients undergoing 19 surgical procedures on the elbow joint. We measured the resting EMG signal intensity of the biceps and triceps of the operated and the normal sides at 90 degrees. We then calculated the peak EMG signal intensity during passive elbow flexion and extension of the operated side. Results: Seventeen of 19 elbows (89%) displayed a co-contraction pattern of the biceps and triceps near the end of flexion and extension during the passive range of motion. The co-contraction pattern was observed near the end of the range of motion in both flexion and extension. In addition to the observed co-contraction patterns, we detected higher contraction intensities for the biceps and triceps muscles in all patients in both flexion and extension for the elbows, which had been treated surgically. Further analysis suggests an inverse correlation between the biceps contraction intensity and the arc of motion measured at the latest follow-up. Conclusion: The co-contraction pattern and increased contraction intensity of periarticular muscle groups may result in internal splinting mechanisms, contributing to the development of elbow joint stiffness, which is frequently observed following elbow surgery. Level of evidence: III


Main Subjects

1. Jupiter JB, O'Driscoll SW, Cohen MS. The assessment and
management of the stiff elbow. Instr Course Lect. 2003;
2. Weiss AP, Sachar K. Soft tissue contractures about the elbow.
Hand Clin. 1994; 10(3):439-51.
3. Morrey BF. Surgical treatment of extraarticular elbow
contracture. Clin Orthop. 2000 ;( 370):57-64. DOI:
4. Kachooei AR, Baradaran A, Ebrahimzadeh MH, van Dijk CN,
Chen N. The Rate of Radial Head Prosthesis Removal or
Revision: A Systematic Review and Meta-Analysis. J Hand
Surg Am. 2017; DOI:10.1016/j.jhsa.2017.08.031.
5. Ye F, Yang B, Nam C, Xie Y, Chen F, Hu X. A Data-Driven
Investigation on Surface Electromyography Based Clinical
Assessment in Chronic Stroke. Front Neurorobot. 2021;
15:648855. DOI:10.3389/fnbot.2021.648855.
6. Sakurai G, Ozaki J, Tomita Y, et al. Electromyographic analysis
of shoulder joint function of the biceps brachii muscle during
isometric contraction. Clin Orthop. 1998; 10(354):123-31.
DOI: 10.1097/00003086-199809000-00015.
7. Yamaguchi K, Riew KD, Galatz LM, Syme JA, Neviaser RJ.
Biceps activity during shoulder motion: an
electromyographic analysis. Clin Orthop. 1997 ;( 336):122-9.
DOI: 10.1097/00003086-199703000-00017.
8. Funk DA, An KN, Morrey BF, Daube JR. Electromyographic
analysis of muscles across the elbow joint. J Orthop Res. 1987;
5(4):529-38. DOI: 10.1002/jor.1100050408.
9. Cronenwett JL, Zelenock GB, Whitehouse WM, Stanley JC,
Lindenauer SM. The effect of sympathetic innervation on
canine muscle and skin blood flow. Arch Surg. 1983;
118(4):420-424. DOI:
10. Beredjiklian P, Kachooei AR, Gallant G, et al. Abnormal
Patterns of Biceps and Triceps Co-Contraction Following
Elbow Surgery May Result in Elbow Stiffness. Archives of
Bone and Joint Surgery. 2023. DOI:
11. Mohiuddin M, Lee NH, Moon JY, et al. Critical limb ischemia
induces remodeling of skeletal muscle motor unit,
myonuclear-, and mitochondrial-domains. Scientific Reports.
2019; 9(1):9551.
12. Wang R, Wang M, He S, Sun G, Sun X. Targeting calcium
homeostasis in myocardial ischemia/reperfusion injury: an
overview of regulatory mechanisms and therapeutic
reagents. Front Pharmacol. 2020; 11:872. DOI:
13. Cady E, Elshove H, Jones D, Moll A. The metabolic causes of
slow relaxation in fatigued human skeletal muscle. J Physiol.
1989; 418(1):327-337. DOI:
14. Page C, Backus SI, Lenhoff MW. Electromyographic activity in
stiff and normal elbows during elbow flexion and extension. J
Hand Ther. 2003; 16(1):5-11. DOI: 10.1016/s0894-
15. Osu R, Franklin DW, Kato H, et al. Short-and long-term
changes in joint co-contraction associated with motor
learning as revealed from surface EMG. J Neurophysiol. 2002;
88(2):991-1004. DOI: 10.1152/jn.2002.88.2.991.
16. Allum J, Mauritz K. Compensation for intrinsic muscle
stiffness by short-latency reflexes in human triceps surae muscles. J Neurophysiol. 1984; 52(5):797-818. DOI:
17. Freibott CE, Bäcker HC, Shoap SC, Tedesco LJ, Galle SE,
Rosenwasser MP. Treatment methods for post-traumatic
elbow stiffness caused by heterotopic ossification. J Shoulder
Elbow Surg. 2020; 29(7):1380-
18. Tfelt-Hansen P, Meritam Larsen P, van Deurs U, Fabricius M.
Can tendon reflexes be elicited by both stretch and vibration
in man? Brain Behav. 2021; 11(7):e02191.
Volume 11, Issue 6
June 2023
Pages 398-403
  • Receive Date: 02 April 2022
  • Revise Date: 21 April 2023
  • Accept Date: 24 April 2023
  • First Publish Date: 20 May 2023