Fig. 1

A 44 years old man developed left elbow stiffness after a fall-induced sprain, he experienced six months of conservative care to restore elbow movement but with limited improvement. Surgical release was conducted to improve the range of motion. A, B Significant limitation in both flexion and extension of the elbow joint before operation. C After anesthesia induction, the patient is positioned laterally with the affected elbow facing upwards and placed on a hand table. D, E The medial and lateral incisions measure 3 and 4 cm, respectively. F The procedure begins by rotating the elbow laterally to expose the inner side. A longitudinal incision, approximately 3 cm in length, is made extending proximally from the midpoint of a line connecting the medial epicondyle of the humerus to the tip of the olecranon. Adhesions and scar tissue are meticulously dissected and released from the ulnar nerve, which is then repositioned anteriorly to prevent further compression. G The posterior bundle of the ulnar collateral ligament is cut to access the olecranon fossa from the medial side of the triceps brachii. Scar tissue in the olecranon fossa, posterior joint capsule, and the inner surface of the triceps brachii is cleaned until normal muscle tissue is exposed. Heterotopic ossification tissue is removed simultaneously if present. The ulnar nerve is then transposed between the deep fascia and muscle, and the deep fascia is fixed to the medial epicondyle of the humerus using an anchor. H The elbow is then rotated medially to expose the lateral side. A longitudinal incision, approximately 4 cm in length, is made extending proximally from the humeroradial joint space along the lateral supracondylar ridge of the humerus. The extensor carpi radialis longus and its tendon are carefully dissected to access the coronoid fossa. Contracture scar tissue from the joint capsule and the inner surface of the brachialis muscle is removed until normal muscle or tendon is exposed. I, J After the removal of visible contracture tissue from both medial and lateral incisions, the elbow joint is slowly flexed and extended, and the forearm is rotated to the maximum angle to check for any residual adhesion tissue that still limits motion