Elbow Arthritis
What is elbow arthritis?
Osteoarthritis of the elbow is a chronic degenerative disorder which occurs when the cartilage surface of the elbow is damaged or becomes worn. The elbow is one of the least affected joints because of its well matched joint surfaces and strong stabilizing ligaments.
Anatomy
The elbow joint is a very stable & hinged joint. The ulnar nerve supplies feeling to the little & ring finger. It also supplies motor power to 15 out of 20 small muscles in hand.
Causes:
- Osteoarthritis: (OA): It is also known as “wear-and-tear” arthritis. In osteoarthritis is a condition that destroys the smooth lining (articular cartilage) of bone. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. During movement, the bones of the joint rub against each other, causing pain.OA usually affects people over 50 years of age.
- Rheumatoid Arthritis: (RA)RA is a chronic disease that attacks multiple joints throughout the body. Rheumatoid arthritis causes the lining to swell, which causes pain and stiffness in the joint.
- Post Traumatic Arthritis: (PTA)This usually follows injury to the elbow joint causing damage to the cartilage. It may occur after an initial fracture repair has been attempted.
Symptoms:
- Pain: Especially with lifting and loading the arm. There may also be aching sensation in forearm with tingling and numbness in the ring and little fingers. Progressively may get pain at night
- Locking and clicking / clunking sensation in elbow, may or may not be associated with pain.
- Stiffness of elbow – as the arthritis progresses the elbow may become stiff and cause problems with activities of daily living
- Pins and needles and numbness in ulnar nerve distribution in hand. May be associated with clumsiness in fingers when doing fine motor activities ie doing buttons, holding small change etc.
Diagnosis:
The diagnosis of elbow arthritis is based on the above symptoms and usually confirmed by plain radiographs (see below). If patients have symptoms of ulnar nerve compression, then this diagnosis is confirmed using Nerve Conduction Studies (NCS)
A CT scan may be ordered to look at the damage to the joint and any loose bodies present if surgery is being planned.
Treatment:
- For the early stages of osteoarthritis of the elbow, the most common treatment is nonsurgical. This includes oral medications to reduce or alleviate pain, rest and activity modification.
- Physical therapy may be helpful in early stages when the symptoms are mild.
- Corticosteroid injections are sometimes used to treat osteoarthritis symptoms. The effects of injections are temporary, they can provide significant pain relief until symptoms progress enough to need additional treatment.
- Platelet Rich Plasma (PRP) which is usually performed in an operating suite using ultrasound or image guided. This has shown to be of benefit in some cases and is considered experimental.
- Visco supplementation – hyaluronic acid in various forms, called viscosupplementation have been injected into the joint to improve the quality of the joint fluid.
Elbow Arthroscopy / Key Hole Surgery
- For patients who are too young or too active to have prosthetic joint replacement, the surgeon can release the contracture and smooth out the joint surface. 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. It can be done as a day case procedure, and recovery is reasonably rapid.
- Elbow Replacement: 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.