Osteoarthritis of the Elbow
Elbow osteoarthritis is degenerative change of the elbow joint that can cause pain and stiffness.
What parts of the elbow are affected?
The elbow joint is made up of three bones: the humerus bone of the upper arm, and the ulna and radius bones of the forearm. The ulna and the humerus meet at the elbow and form a hinge. This hinge allows the arm to straighten and bend. connection of the radius to the humerus and the ulna allows the forearm to rotate. The upper end of the radius is round. It turns against the ulna and the humerus as the forearm and hand turn from palm down (pronation) to palm up (supination).
In the elbow joint, the ends of the bones are covered with articular cartilage. Articular cartilage is a slick, smooth material. It protects the bone ends from friction when they rub together as the elbow moves. Articular cartilage is soft enough to act as a shock absorber. It is also tough enough to last a lifetime, if it is not injured.
What causes osteoarthritis?
Osteoarthritis is caused by degeneration of the articular cartilage of a joint.
Primary osteoarthritis is when the the degenerative changes occur without a specific cause. Post-traumatic arthritis occurs after an injury, which may have occurred many years previously. An inury may damage the cartilage directly. Pieces of the cartilage can actually be ripped away from the bone and if the pieces aren't removed, they may float around in the joint, causing it to catch. These pieces are referred to as loose bodies. They can also cause a lot of pain and do more damage to the joint surfaces. Any injury to the elbow joint can also change the way the joint works. For example, after an elbow fracture the bone fragments may not line up exactly. They heal slightly differently from their condition before the injury. Even this slight difference can cause the joint to begin the cycle of wear and tear. It's just like a machine: if the mechanism is out of balance, it wears out faster.
What symptoms does osteoarthritis cause?
Pain and stiffness are the main symptoms of osteoarthritis of any joint. At first, the pain is related to activity. Most of the time the pain lessens while doing the activity, but after resting for several minutes pain and stiffness increase. As the condition worsens, you may feel pain even when resting. The pain may interfere with sleep. You may have swelling around your elbow. Your elbow joint may fill with fluid and feel tight, especially after using it. When all the articular cartilage is worn off the joint surface, you may begin hearing a squeak and feel a creak in the joint when you move your elbow. This creaking sensation is called crepitus.
Osteoarthritis eventually affects the elbow's motion. The first thing most people notice is that it becomes hard to completely straighten the arm. Later they find it hard to bend. Loss of motion leads to weakness and decreased function. Carrying heavy objects at the side of the body with the elbow straight is especially difficult.
How is it diagnosed?
The diagnosis of osteoarthritis of the elbow begins with a medical history of the problem. Your doctor will ask may questions about your pain, how it affects your daily activities, and any past injuries to your elbow. Because osteoarthritis develops over a long time, you may be asked questions about things you did long ago. For example heavy manual labourers have a higher risk of developing osteoarthritis of the elbow later in life. Your doctor will also do a physical examination of the elbow and possibly other joints in the body. X-rays are usually the best way to see what is happening with your bones. X-rays can help your doctor assess the damage and track how your joint changes over time. X-rays can also help your doctor see how many bone spurs are present and if there are any loose bodies in the joint. X-rays can also show the size of the joint space and how much articular cartilage is left. CT scans give a 3-D view to show the size and location of any bone spurs present. CT scans can reveal osteophytes that don't appear on plain X-rays. CT scans also show the surgeon how close the bone spurs are to the ulnar nerve. This information is very useful when planning surgery to remove the spurs. Your doctor may order blood tests if there is any question about the cause of your osteoarthritis. Blood tests can show certain systemic diseases, such as rheumatoid arthritis.
What is the treatment?
In almost all cases, doctors try nonsurgical treatments first. Surgery is usually not considered until it has become impossible to control your symptoms. The goal of nonsurgical treatment is to help you manage your pain and use your elbow without causing more harm. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, to help control swelling and pain. Other treatments, such as heat, may also be used to control your pain. Physiotherapy helps you learn how to control symptoms and maximize the health of your elbow.
To get rid of your pain, you may also need to modify or limit your activities. You may even need to change jobs, if your work requires heavy, repetitive motions with the hand and wrist.
An injection of cortisone into the elbow joint can give temporary relief. Cortisone is a powerful anti-inflammatory medication. It can very effectively relieve pain and swelling. Its effects are temporary, usually lasting several weeks to months. There is a small risk of infection with any injection into the joint, and cortisone injections are no exception.
Eventually, it may be necessary to consider some type of surgical treatment. There are several operations to treat advanced osteoarthritis of the elbow. Your surgeon will consider many factors when deciding which procedure is best for you, including the severity of joint degeneration, your age, your activity level, and how you use your elbow.
If you are in an early stage of osteoarthritis, your doctor may recommend arthroscopic debridement. Arthroscopic procedures use an arthroscope, a tiny TV camera that is inserted into the joint through a very small incision. The arthroscope allows the surgeon to see inside the elbow joint. In arthroscopic debridement, the surgeon makes other small incisions for inserting special tools to get rid of bone spurs, remove loose bodies, or smooth the cartilage. Sometimes a capsular release is needed. The capsule is a fibrous covering around the joint. An incision is made in the tissue and the anterior (front) of the capsule is removed. If the arthritis is more advanced, a larger incision may be required to perform the surgery.
Elbow joint replacement or total elbow arthroplasty (TEA) is not nearly as common as hip, knee, or shoulder replacement. This is true for a couple of reasons. Osteoarthritis in the elbow is not as common as osteoarthritis in weight-bearing joints. Elbow joint replacement also has a higher complication rate than the more common replacement surgeries. The elbow joint replacement is a good choice for patients who need improved motion rather than strength. Older patients who don't need as much strength will probably prefer the results of elbow replacement surgery. They must be willing to accept low levels of activity involving the elbow. Patients with advanced rheumatoid arthritis are also good candidates for total elbow arthroplasty (TEA).