Elbow arthritis
What is elbow arthritis?
Arthritis of the elbow develops when the cartilage of the elbow is damaged or becomes worn out. This can happen because of wear and tear but may be due to a previous injury such as elbow dislocation or a broken bone. Osteoarthritis usually affects the weight-bearing joints, such as the hip and knee. The elbow is one of the least affected joints because of its highly congruent joint surfaces and strong stabilizing ligaments. As a result, the elbow joint can tolerate large forces across it without becoming unstable.
Diagnosis
There is usually a history of increasing pain and stiffness which is worse after periods of activity. There are 3 articulations within the elbow joint and it is important that your doctor or surgeon identifies the exact cause of the pain and stiffness coming from your elbow. One or more of the conditions bellow may need to be addressed.
Pain can be coming from the radial head; which will be best treated with excision or replacement of the radial head.
Contracture of the soft tissues which form the capsule of the joint can cause stiffness and can be treated with a soft tissue release alone.
Elbow arthritis can cause irritation to the Ulna nerve. In the later stages of osteoarthritis of the elbow, patients may notice numbness in their ring finger and small finger. This can be caused by elbow swelling or limited range of motion in the joint. The "funny bone" (ulnar nerve) is located in a tight tunnel behind the inner (medial) side of the elbow. Swelling in the elbow joint can put increased pressure on the nerve, causing tingling. If the elbow cannot be moved through its normal range of motion, it may stiffen into a position where it is bent (flexion). This can also cause pressure around the nerve to increase. Pain from the nerve can be worse than the worn out joint and decompression of the ulna nerve can significantly alleviate symptoms.
When bone gets worn it tries to heal itself by producing extra bone. This takes the form of small nodules of bone which appear at the edge of the joint and are called osteophytes. These can be large enough to block the range of motion. In a highly congruent joint such as the elbow these block the joint stopping it from going straight (extension) or bending (flexion). When the osteophytes get in the way they 'impinge' trapping soft tissues and cause pain. The osteophytes can be burred away with keyhole surgery. Occasionally they are too large and more extensive surgery is required.
The osteophytes can break off and become free pieces of bone and cartilage which float around the elbow joint. These are called loose bodies. They can be symptom free but occasionally they get caught in the joint and jam in the hinge. The pain they create is sudden and intermittent and often resolves by shaking the arm leaving it nearly symptom free once more. This is called locking and is best treated by removing the loose bodies with keyhole surgery.
Why do I have elbow arthritis?
Trauma; Most patients who are diagnosed with elbow osteoarthritis have a history of a fracture that involved the surface of the joint, or an elbow dislocation.
Injury to the ligaments can cause them to stretch resulting in an unstable elbow which can also lead to osteoarthritis. The normal forces which act across the elbow joint during normal flexion and extension are altered, causing the joint to wear out more rapidly on one side. This often results in the tip of the olecranon impinging in the back of the elbow joint on the inside of its fossa. This is called postero-lateral impingement
In some patients, no single injury to the elbow occurs. Work or outside activities can lead to osteoarthritis of the elbow if the patient places more demands on the joint than it can bear.
The best way to prevent elbow arthritis is to avoid injury to the joint. When injury does occur, it is important to recognize it right away and get treatment. Individuals involved in heavy work or sports activities should maintain muscular strength around the elbow. Proper conditioning and technique should always be used.
Treatment
Treatment options depend on the stage of the disease, prior history, what the patient desires, overall medical condition, and the results of diagnostic X-rays.
What are the non operative treatments?
For the early stages of osteoarthritis of the elbow, the most common treatment is nonsurgical. This includes pain killers to reduce or alleviate pain, physiotherapy, and activity modification.
Corticosteroid injections are sometimes used to treat osteoarthritis symptoms. Steroid can be injected under x-ray guidance and typically has good results. Although the effects of injections are temporary, they can provide significant pain relief until symptoms progress enough to need surgical treatment.
An alternative to steroids has been the injection of hyaluronic acid in various forms. Hyaluronic acid is used to increase the fluid in a joint, a process called viscosupplementation, by surrounding the diseased cartilage with a thicker and more "cushioned" environment. This treatment has been recently studied in people with osteoarthritis of the knee. Although there was initial enthusiasm for this treatment, research has not shown it to be better than traditional steroid injections. Additionally, hyaluronic acid injections were significantly more expensive than steroid injections. The long-term results of these "viscosupplementation" injections in the elbow or other joints have not yet been investigated.
Surgical Treatment
When nonsurgical interventions are not enough to control symptoms, surgery may be needed. By the time arthritis can be seen on X-rays, there has been significant wear or damage to the joint surfaces. If the wear or damage is limited, arthroscopy can offer a minimally invasive surgical treatment. It may be an option for patients with earlier stages of arthritis.
Arthroscopy has been shown to provide symptom improvement at least in the short term. It involves removing any loose bodies or inflammatory/degenerative tissue in the joint. It also attempts to smooth out irregular surfaces. Multiple small incisions are used to perform the surgery. It can be done as a day case procedure, and recovery is reasonably rapid.
If the joint surface has worn away completely, it is unlikely that anything other than a joint replacement would bring about relief. There are several different types of elbow joint replacement available. The improvement in pain and function can be dramatic. With an experienced surgeon, the results for elbow joint replacement should be as good as those for hip and knee replacement.
For patients who are too young or too active to have prosthetic joint replacement, there are other reasonably good surgical options. If loss of motion is the primary symptom, the surgeon can release the contracture and smooth out the joint surface. At times, a new surface made from the patient's own body tissues can be made. These procedures can provide years of symptom improvement.
Animation of surgical debridement
