Objective: To elucidate the MRI findings of stiff elbow in adult and determine their values in the preoperative diagnosis of the mechanism of stiffness.

Patients and methods: This prospective study included MR images of 39 stiff elbow joints in 36 nonconsecutive patients referred to MRI unit in Diagnostic Radiology Department at Sohag University Hospital between October 2011 and December 2014. They were 19 males and 17 females, (mean age, 31 years). Surgical correlation was available in all patients. MRI diagnosis of the elbow pathology and mechanism of stiffness were reported and correlated with the surgical findings.

Results: In descending order of frequency, post-traumatic arthritis was the most common etiology of elbow stiffness (36%), followed by rheumatoid arthritis (28%), then septic arthritis (14%), osteochondral lesions (11%), hemophilia; (5%) and lastly synovial osteochondromatosis (3%) and primary osteoarthritis (3%). MRI was 100% accurate in diagnosis of elbow pathology and 96% accurate in detection of mechanism of stiffness (ranging from 87% to 100% for osseous abnormalities and from 92% to 100% for soft tissues abnormalities) compared with surgical findings.

Conclusion: MR examination is valuable in the preoperative evaluation of both soft tissue and bony causes of elbow stiffness in a variety of elbow pathologies